Is the Trend of Amputation in Nigeria Changing? A Review of 51 Consecutives Cases seen at Federal Medical Centre Ebute Metta, Lagos, Nigeria.

Abstract

Introduction: Many previous studies from Nigeria have recognized trauma and complications of management of musculoskeletal conditions by traditional bone setters (TBS) as the leading cause of amputation in Nigeria. However, of recent, a number of the studies are showing that diabetes gangrene which used to be an uncommon indication is becoming an important cause of extremity amputations. In view of the effect of
amputation on the individual and the society and the success of well designed preventive programs, it is important that the indications for amputation be kept in constant view. The objective of this study is to draw attention to the increasing importance of diabetes gangrene as a leading cause of amputation in Nigeria.
Patient and Methods: This is a three-year prospective study (October 2006 – September 2009) using observer- administered questionnaires after consents were obtained from all patients or proxy during the period of study. All recruited patients were followed up and evaluated after surgery to determine the outcome. The following data were obtained and analyzed – age, sex, amputation type, indication and use of prosthesis.
Results: Fifty-one amputations were performed in fifty patients (37 males and 13 females). M.F = 2.8:1, age range 5 – 85 years, mean 47.6+/- S.D 20.7. Major limb amputations accounted for 35 cases (68.6 %) with diabetes gangrene accounting for 23 cases ( 45%) followed by Trauma accounting for 16 cases ( 31%). Wound infection was the commonest complication occurring in 16 cases ( 31.4%), Escherichia coli being the commonest causative organism. Only 6 patients (12%) eventually used prosthesis and the mortality in this series was 8 patients (16%).
Conclusion: Diabetic gangrene is the leading cause of amputation in this series. This is the first study in this environment to the best of the authors’ knowledge where diabetes gangrene will emerge the leading indication. A number of other reports from Nigeria in the last few years have shown
the progressive importance this condition is assuming as a leading cause of amputation.1,3 This finding therefore calls for more studies in this area and a more proactive approach by caring physicians to limb lesions by their Diabetic patients.

Niger Med J. Vol. 51, No. 4,Oct. – Dec., 2010: 167 – 169.

Keywords: amputation, diabetes gangrene, outcome