Foot Ulcer a Devastating Complication of Diabetes Mellitus: A Single-Center Experience of 400 Patients

ABSTRACT

Objective: To identify the clinical predictors of amputation outcomes in patients with diabetic foot ulcers (DFUs) and the management of such patients. Material and Methods: Four hundred (273 men; 127 women) patients with DFUs, who were followed at our clinic between 2008-2014, were included. Patients' demographic characteristics, glycemic parameters, and diabetic complications were evaluated. The amputations were classified as minor (distal to metatarsus) and major (Chopart, and below or upper knee) amputations. Results: The mean age of the patients was 62.4±10.5 years. Three hundred and ninety-five patients had type 2 diabetes mellitus. The mean diabetes duration was 17±8 years. The rate of chronic diabetic complications consisting of neuropathy, nephropathy, and retinopathy were 97.5%, 81.3%, and 94.8%, respectively. Osteomyelitis and peripheral arterial disease rates were 327 (81.8%) and 265 (66%), respectively. The majority of the foot ulcers were of Wagner grade 3 (53.2%) and 4 (27.5%). According to the initial clinical considerations, 60% of the patients were administered empirical antibiotic therapy for infection. The minor and major amputation rates were 110 (25.5%) and 146 (36.3%), respectively. The average glycosylated hemoglobin value was 8.9±2.3%. Peripheral arterial disease [odds ratio (OR): 2.183, 95% confidence interval (CI): 1.242-3.837, p<0.001), osteomyelitis [OR: 5.062, 95% CI: 2.296-11.161, p<0.001) and Wagner grade (OR: 62.352, %95 CI: 7854-495.021, p<0.001) were found to increase the amputation risk. Conclusion: Diabetic neuropathy is still an underlying major risk factor for the development of DFUs. The presence of peripheral arterial disease, osteomyelitis, and high Wagner degree are negative prognostic factors for the need for amputation.