Retrospective analysis of diabetic patients with foot infections

factors related to the level of amputation and wound healing

Abstract

Objective: The objective of this study is to trace the epidemiological profile of diabetic patients attended at the two Orthopedics tertiary hospitals and assess the influence of clinical and laboratory parameters in determining the level of amputation of limbs and the length of wound healing. Methods: Between April 2007 and December 2012, data of 139 diabetic patients were retrospectively collected. They underwent some type of surgical procedure in the lower limbs due to infection and/or ischemic necrosis of the affected limb. Epidemiological data, type of surgery (amputation and their types, debridement), antibiotic use, laboratory parameters, length of stay and outcome variables were considered in this study. The level of statistical significance was 5%. Results: One hundred-six patients (76.3%) were male. The mean age was 64 years. The most prevalent surgical intervention was amputation, occurring in 90 subjects (54.9%). The most common amputation level was transmetatarsal, in 26 patients (28.9%). The average time between the fisrt surgery and the final closing of the wound was 35 days. The mean hospital length stay was 23 days. The wound closure time increased with statistical significance in individuals who were not submitted to amputation, who underwent debridement, who did not use preoperative antibiotics and who underwent cardiovascular intervention. Higher level of amputation were statistically related to limb ischemia, previous amputation, patients which had not been debrided and individuals who had not used antibiotics preoperatively. Conclusion: Risk factors for major amputations were ischemia and previous amputations. Protective factor was the use of ATB preoperatively. The healing time of wounds decreases if the patient was amputated or if he used ATB preoperatively and increases if the patient underwent vascular intervention, has higher leukocyte levels preoperatively and/or had their limb preserved, leading to multiple debridement.