Diabetic Foot Amputation Research Articles

Depression as a Prognostic Factor in Lower Extremity Amputation for Diabetic Foot: Insights From a Prospective Study on Wound Healing, Infections, and Early Mortality

This study addresses the challenges faced by diabetic patients undergoing lower extremity amputation due to diabetic foot, particularly focusing on the implications for wound healing and early mortality. The wounds at the amputation stump may necessitate multiple surgical interventions. The aim is to identify prognostic factors associated with these outcomes, shedding light on the complexities surrounding the postamputation phase. A prospective study was conducted on 39 diabetic patients who underwent lower extremity amputation due to diabetic foot between 2021 and 2022. Comprehensive preoperative data, encompassing parameters such as blood count, erythrocyte sedimentation rate, C-reactive protein, procalcitonin, hemoglobin A1c, albumin, protein, transferrin, ferritin levels, age, gender, body mass index, smoking habits, dialysis, revascularization, duration of surgery, and the use of tourniquet during the procedure were meticulously recorded. Additionally, cognitive performance and depression status were assessed preoperatively using the Mini-Mental State Examination (MMSE) and Beck Depression Inventory (BDI), respectively. A follow-up period of 3 months postsurgery allowed for the comparison of patients who developed infections at the amputation stump with those who did not, as well as the distinction between patients who survived and those who succumbed to mortality. The study revealed that the use of a tourniquet during surgery significantly increased the risk of infection (p = .027), and higher BDI scores were associated with increased risks of both infection (AUC = 0.814) and mortality (AUC = 0.769), with cut-off scores of 24.0 and 23.5 predicting these outcomes with high sensitivity and specificity, respectively. Additionally, lower MMSE scores were associated with increased short-term postoperative mortality. There were no statistically significant differences between the groups in parameters such as complete blood count, ESR, CRP, procalcitonin, HbA1c, albumin, total protein, transferrin, ferritin levels, age, gender, BMI, smoking, dialysis, revascularization, and surgery duration. This investigation highlights the significance of considering tourniquet usage during amputation, preoperative depression status, and cognitive function in patients who undergo amputation due to diabetic foot. The use of a tourniquet during surgery is a significant risk factor for infection, and elevated BDI scores are strong predictors of both infection and mortality in patients undergoing amputations. The findings underscore the importance of a multidisciplinary neuropsychiatric evaluation preoperatively to enhance patient care and outcomes.

Red Blood Cell Distribution Width: A Novel Predictor of Mortality Following Amputation in Diabetic Foot

Category: Diabetes; Other Introduction/Purpose: Red blood cell distribution width (RDW) reflects the degree of heterogeneity of erythrocyte volume. The number of studies investigating the relationship between RDW and various human disorders has exponentially increased over the past decades. However, the association of RDW with diabetic foot amputation has not been evaluated to date. In this study, we assessed the value of RDW as a prognostic factor in diabetic foot amputation. Methods: Data on 415 patients with diabetic foot who underwent amputation between January 2009 and January 2019 were analyzed retrospectively. After establishing optimal cut-off point of preoperative RDW for all-cause mortality, univariable and multivariable analyses with Cox proportional hazard model for survivorship and logistic regression for length of hospital stay more than 30 days were performed to identify significant prognostic factors including RDW, other laboratory results, demographic variables and co-morbidities. Results: RDW cut-off of 14.5% was found to be significantly associated with all-cause mortality (P < 0.001). High RDW was a significant risk factor or all-cause mortality (hazard ratio[HR]: 2.42, 95% confidence interval [CI]: 1.46 to 4.00) on multivariable- adjusted regression analysis. High RDW was also associated with longer hospitalization (odds ratio: 2.17, 95% CI: 1.29 to 3.66). Conclusion: High RDW over 14.5% value is an independent prognostic factor with increased mortality and prolonged hospital stay, implying that RDW may be a simple and inexpensive laboratory parameter for risk stratification in diabetic foot amputation.

Amputation in diabetic foot ulcer: A treatment dilemma.

Diabetic foot is a clinical manifestation of diabetes with a wide range of symptoms, including ulceration, osteomyelitis, osteoarticular destruction, and gangrene, as a consequence of advanced disease. Some diabetic foot cases present general indications for amputation, including dead limb, threat to the patient's life, pain, loss of function, or nuisance. Various tools have been introduced to help decision-making in amputation for diabetic foot. However, it remains a conundrum because diabetic foot involves multiple pathomechanisms and factors that hinder its outcomes. Sociocultural issues often impede treatment from the patient's side. We reviewed different perspectives in diabetic foot management, particularly related to amputation. In addition to deciding whether to amputate, physicians should address amputation level, timing, and ways to avoid patient deconditioning. Surgeons should not be autocratic in these circumstances and should be aware of beneficence and maleficence when considering whether to amputate. The main goal should be improving the patients' quality of life rather than preserving the limb as much as possible.

Abstract #1321537: Antimicrobial Resistance Level and Associated Risk Factors of Amputation in Diabetic Foot Patients: A Cross-Sectional Study From Pakistan

Diabetic foot is a major and much dreaded complication of diabetes. If not managed properly it leads to amputation, resulting in severe disability and poor quality of life. Unfortunately, there is low literacy, poverty, widespread antibiotic abuse, and high AMR levels in developing countries like Pakistan. In this study we sought to identify the demographic, clinical, and laboratory parameters of diabetic foot patients. We also performed AMR surveillance study and explored the associated risk factors that lead to amputation in diabetic foot.

Predictive factors and nomogram to evaluate the risk of below-ankle re-amputation in patients with diabetic foot

Background Diabetes mellitus, as the most common metabolic disease, is common worldwide and represents a crucial global health concern. The purpose of this research was to investigate the related risk factors and to develop a re-amputation risk nomogram in diabetic patients who have undergone an amputation. Methods A observational analysis was performed on 459 patients who have underwent amputation for diabetic foot from January 2014 through December 2019 at the First Affiliated Hospital of Wenzhou Medical University. The least absolute shrinkage and selection operator regression and stepwise regression methods were implemented to determine risk selection for the re-amputation risk model, and the predictive nomogram was established with these features. Calibration curve, receiver operating characteristic curve, and decision curve analysis of this re-amputation nomogram were assessed. Results Predictors contained in this predictive model included smoking, glycated hemoglobin A1c (HbA1c), ankle-brachial index (ABI) and C-reactive protein (CRP). Good discrimination with a C-index of 0.725 (95% CI, 0.6624–0.7876) and good calibration were displayed with this predictive model. The decision curve analysis showed that this re-amputation nomogram predicting risk adds more benefit than none strategy if the threshold probability of a patient was >6% and <59%. Conclusions This novel re-amputation nomogram incorporating smoking, glycated hemoglobin A1c (HbA1c), ankle-brachial index (ABI), C-reactive protein (CRP), and smoking could be easily used to predict individual re-amputation risk prediction in diabetic foot patients who have undergone an amputation. In the future, further analysis and external testing will be needed as much as possible to reconfirm that this new Nomogram can accurately predict the risk of toe re-amputation.

Epidemiology of Diabetes Foot Amputation and its Risk Factors in the Middle East Region: A Systematic Review and Meta-Analysis.

This study aimed to review epidemiology of diabetic foot (DF) amputation and provide a pooled estimation of DF amputation rate in the region. A comprehensive search was performed in Web of Science, PubMed, Scopus and EMBASE databases using appropriate search term. Obtained records were entered endnote software and after removing duplicats were screened by title, abstract and full text. Data was extracted from the remained documents. Random effect meta-analysis was used to pool the estimated prevalence rate due to sever heterogeneity between studies. Finally 17 articles in diabetes, 20 in patients with DFU (diabetic foot ulcer) and two in both remained after screening and included in meta-analysis. Overall pooled amputation rate in diabetes was 2% (95% CI: 1%-3%) which was not significantly different between countries. The pooled prevalence of amputation rate in DFU patients was 33% (24%-43%) and the pooled prevalence in Saudi Arabia was significantly higher than in other countries. The estimated rate of foot amputation in diabetes patients and those with DFUs in the Middle East region is approximately high, which may indicate low quality of preventive foot care, low socioeconomics and low patients awareness or education in countries with high amputation rate.

Factors that Affect the Level of Lower Limbs Amputation in Diabetic Foot: Educational Corner

The article's abstract is not available.

Red Blood Cell Distribution Width: A Novel Predictor of Mortality Following Amputation in Diabetic Foot

Category:DiabetesIntroduction/Purpose:Red blood cell distribution width (RDW), reflects the degree of heterogeneity of erythrocyte volume, has been found to be a significant prognostic factor in various human disorders. Herein, we assessed the value of RDW as a prognostic factor in diabetic foot amputation.Methods:Data of 415 patients with diabetic foot underwent amputation between January 2009 and January 2019 were analyzed retrospectively. After establishing a cut-off point of preoperative RDW for all-cause mortality, Cox proportional hazard model for mortality and logistic regression analysis for length of hospital stay more than 1 month were performed with other variableResults:RDW >14.5% was a significant risk factor for mortality (hazard ratio, 2.55; 95% confidence interval [CI], 1.55 to 4.19) on multivariable-adjusted regression analysis. Other significant factors associated with mortality were age and kidney disease. High RDW was also associated with longer hospitalization over 30 days (odds ratio, 2.17; 95% CI, 1.29 -3.66).Conclusion:High preoperative RDW over 14.5% is an independent prognostic factor with increased mortality and longer hospitalization, implying that RDW may be a simple and inexpensive laboratory parameter for risk stratification in diabetic foot amputation.

A Study of the Risk Factors Predicting Amputation in Diabetic Foot

Background: Diabetic foot ulcers are the main cause of non-traumatic lower extremity amputation. The objective of this study was to evaluate the risk factors for major amputation in diabetic foot patients. Materials &amp; Methods: This open, single center, prospective and observational study conducted in Chalmeda Anand Rao Institute of Medical Science, Karimnagar for a period from Nov. 2018 to Dec. 2020 The patients admitted in General Surgery with diabetic foot problems were selected for the study with proper consent of patients and his/her attendants. Results: In this study Fifty patients were admitted to the diabetic wound in Department of Surgery for foot ulcers between Nov 2018 to Dec 2020. Among the 50 patients, Male: Female ratio was 4.6:1. out of which 41 (82.0%) were male, 18 (36.0%) belonged to the 50 to 59 years age group, 15 (30.0%) were having complaints for Ulcer, 15 (30.0%) were smoker. The Amputation rate was 42.0%. Conclusion: In the results of analysis, poor glycemic control, peripheral arterial disease, peripheral neuropathy and higher Wagner grade are significant risk factors for amputation in diabetic foot infection. Keywords: Diabetic foot, Wagner grading, HbA1c, TLC, Albumin.

Surgical strategies for prevention of amputation of the diabetic foot

Prevention of amputation has become a key objective of clinicians providing care to patients with high-risk diabetic foot problems. In this regard, the multidisciplinary diabetic foot team (MDFT) has been embraced as the most effective way to manage patients with foot ulcers, infections, and Charcot feet. Importantly, such specialized teams have also integrated various surgical specialties to enable more expedient management of these often complex conditions. Experienced diabetic foot surgeons over the last three or four decades have contributed much to this discipline, whereby foot-sparing reconstructive procedures or minor amputations have become fundamental strategies for limb preservation teams. Central to limb salvage, of course, is the recognition of underlying vascular insufficiency and the importance of prompt (endo)vascular intervention. Restoration of adequate perfusion is essential to allow the podiatric, orthopaedic, or plastic surgeon to perform indicated functional reconstructive or minor amputation procedures. This evidence-based overview discusses the various indications and surgical principles inherent in modern concepts aimed at preventing amputation in the high-risk diabetic foot.

Bony Defects of the Foot Lead to High Rates of Transfer Lesion Development: Soft Tissue Reconstruction Is Not Enough in the Chronic Wound Population

BACKGROUND: Bony resection is often necessary before soft tissue reconstruction in the chronic wound population due to osteomyelitis and bony abnormalities. Although transmetatarsal amputation is argued to be the most functional approach when extensive bony resection is required, recent evidence suggests preservation of the first 2 rays may improve load-bearing at the expense of an increased risk of subsequent procedures.1 Altering the metatarsal parabola also increases the risk of transfer lesion development as one metatarsal takes on more weight. The aim of this study was to investigate the risks of ulcer recurrence and transfer lesion development after microsurgical soft tissue reconstruction with underlying bony defects. METHODS: A retrospective review of lower extremity free tissue transfer (FTT) for chronic wounds with underlying bony defects at our institution from 2011 to 2019 was performed. Data collected included demographics, comorbidities, wound locations, and FTT characteristics. Outcomes of interest were ulcer recurrence and development of transfer lesions post-FTT. Multivariate logistic regression was used to produce adjusted odds ratios for transfer lesion development using a backward model. RESULTS: We identified 64 FTT procedures performed for lower extremity salvage with bony defects. Mean age at time of FTT was 55.9 years old (SD = 11.8). Mean Charlson Comorbidity Index was 4.1 (SD = 2.0). Common comorbidities included: diabetes 76.6% and osteomyelitis 68.8%. The majority of bony defects involved the tripod of the foot (79.7%) with resection of a portion of the first metatarsal (46.9%), fifth metatarsal (51.6%) or calcaneus (21.9%). Wounds developed post-FTT in 70.3%. The original ulcer recurred in 39.1% while transfer lesions developed in 43.8%. Median time to transfer lesion development was 3.7 months. On bivariate analysis, neither tripod (P = 0.104), first metatarsal (P = 0.053), nor fifth metatarsal (P = 0.198) defects had significant relationships with increased odds of transfer lesion development. Calcaneal defects also did not exhibit a significant relationship with transfer lesion development (P = 0.939). Diabetes (P = 0.043) and plantar weightbearing defect (P = 0.045) exhibited significant relationships with transfer lesion development. On multivariate analysis, both first metatarsal (odds ratio [OR], 7.2; 95% CI, 1.6–31.8) and plantar weightbearing defects (OR, 4.6; 95% CI, 1.1–19.1) were independently associated with increased odds of transfer lesion development. Fasciocutaneous flap type was significant for decreased odds of transfer lesions (OR, 0.15; 95% CI, 0.03–0.66). Diabetes was no longer a significant predictor for transfer lesion development. CONCLUSIONS: Defects of the load-bearing tripod, particularly the first and fifth metatarsal, significantly increase the risk of transfer lesion development after FTT. While solely soft tissue reconstruction with FTT achieves success in the short term, transfer lesions occur at high rates in the months to years following initial healing. Use of composite osteocutaneous flaps may be valuable in this population to decrease transfer lesion risk by achieving both bony and soft tissue reconstruction. REFERENCE: 1. Suh YC, Kushida-Contreras BH, Suh HP, et al. Is reconstruction preserving the first ray or first two rays better than full transmetatarsal amputation in diabetic foot? Plast Reconstr Surg. 2019;143:294–305.

Analysis of routine blood markers for predicting amputation/re-amputation risk in diabetic foot.

Diabetic foot is challenging progressive disease which requires multisystemic control. Neuropathy, arteriopathy, and cellular responses should treated collaboratively. Despite all medical advances, diabetic foot can highly resulted with amputation and also re‐amputation can be required because of failed wound healing. In this study, we aimed to investigate the relation between blood parameters and amputation events. Diabetic 323 patients include to the study who referred to orthopaedic clinic for amputation. Amputation levels (amputation levels phalanx, metatarsal, lisfranc, syme, below knee, knee‐disarticulation, above‐knee amputation) and re‐amputations recorded and compared with routine blood parameters. Re‐amputation was observed at 69 patients. The significant difference detected between lower albumin, higher HbA1c, higher CRP levels (P < 0.05) in regards to gross amputation levels, and increased wound depth. Furthermore, lower albumin levels and higher levels of WBC, HbA1c, CRP, and Creatinine were detected in re‐amputation levels. Especially, HbA1c, CRP, and Creatinine levels were found as upper bound of reference line for re‐amputation. The statistically optimal HbA1c cutoff point for diabetes was ≥7.05%, with a sensitivity of 86% and a specificity of 59%. In according to our results, simple blood parameters can be useful for observing the progress of amputation in diabetic foot. Particularly, lower albumin, and higher HbA1c, CRP, and Creatinine levels detected as related with poor prognosis. Besides, screening of HbA1c level seems to be highly sensitive for detecting of re‐amputation possibility.

Treatment of Diabetic Foot with Autologous Stem Cells: A Meta-Analysis of Randomized Studies.

Background This meta-analysis was to evaluate the efficacy of autologous stem cell administration for the treatment of diabetic foot. Methods The electronic databases included PubMed, EMBASE, BIOSIS, Cochrane central, and Google Scholar internet, last updated on May 30, 2019. Evaluated outcomes included the rate of wound healing and amputation. Dichotomous outcomes were described as risk ratios (RR) with 95% confidence intervals (CIs). Statistical analysis was performed with RevMan 5.0 software and STATA 10.0 software. Results Eight randomized controlled trial (RCT) studies were included in this study. The meta-analysis showed a lower amputation (RR 0.25, 95% CI 0.11 to 0.54, I2 = 0) and a higher wound healing rate (RR 2.05, 95% CI 1.67 to 2.51, I2 = 4) in the cell therapy group compared with control. Conclusion This meta-analysis supports the effective role of stem cell therapy in promoting wound healing and decreasing rate of amputation in diabetic foot. In the future, more high quality and well-designed studies are need.

598-P: Risk Factors of Amputation In Patients with Diabetic Charcot Foot In Taiwan

Charcot foot is a rare and severe complication of DM neuropathy. Patients with diabetic Charcot foot could progress to chronic ulcer or amputation in severe condition. However, there were few studies addressing the risk factors of amputation in Charcot foot. This study aimed to compare the risks of chronic ulcer or amputation in diabetic Charcot foot. A total of 25 patients with Charcot foot were enrolled from 2010 to 2019 in Kaohsiung Veterans General Hospital. We analyzed the correlation between underlying diseases with chronic ulcer or amputation. The average of our patients was 55±13.3 years old with 34.4±31.1 months following up. In patients below 50 years old with obesity (BMI&amp;gt;24), higher prevalence of Charcot foot was noted compared with those with BMI&amp;lt;24 (p&amp;lt;0.05). The Charcot foot patients have a 7-times higher risk of amputation compared with patients with chronic ulcer (p&amp;lt;0.05), 2.6-times higher risk compared with patients with peripheral arterial occlusion diseases (p&amp;lt;0.05), and 5-times higher risk with patients with osteomyelitis (p&amp;lt;0.05). A Higher risk of amputation was also noted in Charcot foot patients with more than 2 times debridement (OR:5.05, p&amp;lt;0.05). A higher prevalence of osteomyelitis was noted in patients of Charcot foot with chronic ulcer than those without chronic ulcer (p&amp;lt;0.05). Patients with diabetic Charcot foot have a higher risk of amputation compared with patients with chronic ulcer or peripheral arterial occlusion diseases. Osteomyelitis should be aware in chronic ulcer patients with Charcot foot. It’s important to control the ulceration and infection progression in this group of patients. Overweight is an important risk factor for Charcot foot in young patients. Disclosure Y. Tseng: None. L. Chen: None.

Risk factors affecting amputation in diabetic foot.

BackgroundA diabetic foot is the most common cause of non-traumatic lower extremity amputations (LEA). The study seeks to assess the risk factors of amputation in patients with diabetic foot ulcers (DFU).MethodsThe study was conducted on 351 patients with DFUs from January 2010 to December 2018. Their demographic characteristics, disease history, laboratory data, ankle-brachial index, Wagner classification, osteomyelitis, sarcopenia index, and ulcer sizes were considered as variables to predict outcome. A chi-square test and multivariate logistic regression analysis were performed to test the relationship of the data gathered. Additionally, the subjects were divided into two groups based on their amputation surgery.ResultsOut of the 351 subjects, 170 required LEA. The mean age of the subjects was 61 years and the mean duration of diabetes was 15 years; there was no significant difference between the two groups in terms of these averages. Osteomyelitis (hazard ratio [HR], 6.164; 95% confidence interval [CI], 3.561−10.671), lesion on percutaneous transluminal angioplasty (HR, 2.494; 95% CI, 1.087−5.721), estimated glomerular filtration rate (eGFR; HR, 0.99; 95% CI, 0.981−0.999), ulcer size (HR, 1.247; 95% CI, 1.107−1.405), and forefoot ulcer location (HR, 2.475; 95% CI, 0.224−0.73) were associated with risk of amputation.ConclusionOsteomyelitis, peripheral artery disease, chronic kidney disease, ulcer size, and forefoot ulcer location were risk factors for amputation in diabetic foot patients. Further investigation would contribute to the establishment of a diabetic foot risk stratification system for Koreans, allowing for optimal individualized treatment.

To evaluate transmetatarsal amputation in diabetic foot through the Amit Jain's system of practice - An experience from 2 different centre's

The aim of this study was to evaluate trans metatarsal amputation (TMA) done in diabetic foot through Amit Jain’s universal classification and scoring system and assess major amputations done in them. We conducted a descriptive retrospective analysis from 2 center’s namely Amit Jain’s Institute of Diabetic Foot &Wound Care at Brindhavvan Areion Hospital and at Department of surgery, Raja Rajeswari medical college, Bengaluru, India. The study period was from January 2017 to June 2018. 15 patients were recruited in the study with 73.3% of them being males. Around 20 % of them were above 70 years of age. Majority of patients who underwent TMA had open stump and it had significant association with duration of diabetes. Specialist diabetic foot surgeon had significant propensity to close the stump after trans metatarsal amputation (P

Complete Equinus Deformity after Chopart's Amputation for Diabetic Foot: A Case Report

Complete Equinus Deformity after Chopart's Amputation for Diabetic Foot: A Case Report

PO 18105 - Diabetic foot ulcer PEDIS III

Introduction: Infectious agents are associated with amputation of the infected diabetic foot if not promptly treated. It is estimated that 25% of patients with diabetes will present with a foot ulcer at some point of their lives. Our hypothesis is that the microbiological profile isolated from chronic osteomyelitis (CO) secondary to neuropathic foot ulcers is different from the standard profile relayed in the literature. Objective: To determine the microbiological profile and antimicrobial susceptibility patterns of organisms isolated from chronic osteomyelitis (CO) secondary to neuropathic foot ulcers. Furthermore, we aimed to describe the clinical outcomes of 52 patients admitted to a referral diabetic foot center. Methods: Medical charts of 52 patients with clinically infected neuropathic foot ulcers between 2005 and 2013 were reviewed. Osteomyelitis was diagnosed based on suggestive changes on radiographs and magnetic resonance imaging (MRI), and confirmed with a microbiological exam. All cases were followed for at least six months. Only results of bone culture obtained at the time of surgical debridement following antisepsis were considered for microbiological characterization. Results: One hundred and eleven bacterial isolates were identified as causative agents of infection, with a mean 2.13 isolates per patient. There was a predominance of Gram-positive cocci (51%), followed by Gram-negative bacilli (GNB) (43%). The most prevalent agents were Staphylococcus aureus (18%), Enterococcus faecalis (18%) and coagulase-negative Staphylococci (CoNS) (14%). Among S. aureus isolates, the prevalence of methicillin resistance (MRSA) was 48%, and 77% CoNS were methicillin resistant (MRCoNS) with 100% susceptibility to sulfamethoxazole/trimethoprim (SMT/TMP). At 6-month follow-up, 75% of patients were in remission, without signs of infection, 23% of patients presented recurrence of infection, and 2% were lost to follow-up. Conclusion: In diabetic patients with chronic osteomyelitis secondary to neuropathic ulcers, S. aureus, E. faecalis and CoNS were the most frequent agents. The occurrence of MRSA and MRCoNS was high, but with 100% susceptibility to SMT/TMP. Extensive surgical debridement associated with prolonged antimicrobial therapy led to infection remission in 77% of patients after 6 months of follow-up.

Predictors of lower extremity amputation in patients with diabetic foot ulcer

Background: Diabetic foot lesions are responsible for more hospitalisations than any other complication of diabetes and diabetes is a predominant aetiology for non-traumatic lower extremity amputations. Authors, therefore, examined the clinical characteristics that best predict poor outcome in a large population of diabetic foot ulcer patients. The objective of the study was to describe independent predictors for lower extremity amputation in patients with a diabetic foot ulcer and to validate the predictive value of PEDIS (IWGDF) classification system for a diabetic foot ulcer.Methods: A retrospective study of 197 patients presenting with diabetic foot ulcer presenting to a tertiary care hospital in Mysuru, India. The recorded parameters were age, sex, various risk factors, laboratory parameters, the presence of DM-related complications and ulcer characteristics as determined by PEDIS system. The main outcomes recorded were healed ulcer and amputation.Results: Authors have found that factors strongly associated with risk of amputation are (in order of strength): PVD, past amputation, nephropathy, past ulcer, ulcer duration, TLC, Hb and sr. creatinine. Authors also validated the PEDIS scoring system as an effective classification system with prognostic value. The PEDIS score of &gt;7 is a highly significant predictor of adverse outcome (amputation) of diabetic foot ulcer.Conclusions: Several risk factors for lower extremity amputation in a patient with diabetic foot ulcer were identified. An integrated risk-assessment model including the above significant risk factors and PEDIS system can be developed that is both clinically accurate as well as quick to assess for predicting the adverse outcome in a patient of diabetic foot ulcer and providing an opportunity to save the limb.

A meta-analysis of the relationship between foot local characteristics and major lower extremity amputation in diabetic foot patients.

To clarify and quantify risk factors among local characteristics of the foot for major amputation in diabetic foot patients. Articles published before January 2018 on PubMed and Embase were conducted observational studies about risk factors for major amputation in patients with diabetic foot were retrieved and systematically reviewed by using Stata 12.0 statistical software. A total of 4668 major amputees and 65 831 controls were reported in 18 observational studies. Across the studies, the overall odds ratios (ORs) and 95% confidence intervals (CIs) of significant risk factors are ulcer reaching bone (OR, 11.796; 95% CI, 6.905-20.152), gangrene (OR, 6.487; 95% CI, 4.088-10.293), hindfoot position (OR, 3.913; 95% CI, 2.254-6.795), decreased ankle-brachial index (ABI) (OR, 2.522; 95% CI, 1.805-3.523), infection (OR, 2.516; 95% CI, 1.708-3.706), peripheral arterial disease (PAD) (OR, 2.114; 95% CI, 1.326-3.372). While there is no significant difference in the size of the ulcer, neuropathy, Charcot foot, osteomyelitis and intermittent claudication (OR, 1.15; 95% CI, 0.85-1.54). Factors among local characteristics of the foot associated with major amputation in patients with diabetic foot are the ulcer reaching bone, gangrene, hindfoot position, decreased ABI, infection, and PAD, a negative risk factor for the risk of amputation. Further studies are required to provide more details of foot local characteristics.