Pains of amputation amongst diabetic foot ulcer patients in north central Nigeria: amputation versus no amputation

Abstract

Background: Diabetic foot ulcers (DFU) arising from diabetic “foot at risk” are frequent clinical complications of long standing Type 2 Diabetes Mellitus (T2DM) of the elderly patients in this environment. The diabetic patient has a foot at risk of developing infections when not properly cared for. Ulcer prevalence of over 40% T2DM accounts for over 50% of major amputations with high morbidities and mortalities.

The pathophysiology of DFU is multi factorial consisting of peripheral polyneuropathy, arterial disease, and breaches of skin and consequent infections.

Objective: Was to determine patterns, management modalities and treatment outcomes of foot ulcers in chronic diabetics and whether there are no other solutions for the irresistibly damning consequences of Diabetic Foot Ulcers (DFU) namely amputations of extremities with high 5-year mortality index, and to find out what these alternatives are.

Methods: A 5-year retrospective study between June 2012 and June 2017 was undertaken of both type's adult diabetic patients, T1DM and T2DM, with foot ulcers, which were managed surgically at Bingham University Teaching Hospital (BHUTH), Jos, North-Central Nigeria.

Results: Fifty-three 53 (100%) patients with Diabetes Foot Ulcers (DFU) were studied. Fifty-two 52 (98 %) came with advanced ulcers whose limbs could not be salvaged. They were amputated because they came too late with expansive infections. Forty-seven (47) T2DM patients (88.7 %) were discharged home, after amputation of different sorts. We recorded a post amputation mortality of five (5) patients (9.6%). Only one patient, who also came late, a T1DM male patient, was not operated. He was already on insulin and oral anti-diabetic medication at home. Managed with regular wound dressings, his ulcers healed well.

Conclusions: Foot ulcers occur frequently in diabetics who had neglected proper foot care. Chanace of the contralateral limbs becoming also ulcerated and getting amputated with attendant mortality were high.

Keywords: Foot at risk, Diabetic Foot Ulcer, contralateral amputations, salami type-amputations