Do diabetic patients who undergo transtibial amputation receive adequate treatment?

Abstract

AIMS: To determine if patients who undergo below-knee amputation (BKA) for intractable wounds caused by diabetes complications receive adequate treatment before surger

MATERIALS AND METHODS: The study included a total of 528 patients who underwent transtibial amputation for diabetic foot. All patients were assessed on the basis of duration of preoperative treatment, HbO therapy, negative wound pressure therapy (NPWT), peripheral vascular angioplasty (PVA) treatment, wound cultures, antibiotic medications, consultations with plastic and vascular surgeons, need for hemodialysis treatment, use of anticoagulant treatment as an inpatient, and assessment of blood sugar regulation by an endocrinologist. HbA1c, BUN, Creatinine, ESR, and CRP values attained for preoperative assessment were noted.

RESULTS: Eighteen patients (3.5%) received HbO therapy, 35 (6.7%) NPWT therapy and 347 (65.7%) anticoagulant treatment. Wound cultures were taken in 317 patients (60.5%) and 390 (73.9%) received preoperative antibiotic treatment. 45 (8.6%) patients were assessed by plastic surgeon with 22 (4.2%) subsequently undergoing surgery by the plastic surgeon. Vascular surgeons assessed 163 patients (30.9%) and performed procedures on 45 patients (8.6%). Endocrinologists assessed 316 patients (59.8%) and implemented blood sugar regulation. PVA treatment was performed in 246 patients (46.6%). Patients who were managed medically for more than 7 days after the initial assessment received more HbO therapy (p=0.037), anticoagulant treatment (p=0.015), IV antibiotics (0.001), blood sugar regulation attempts (p=0.001), and PVA therapy (0.001) and had more cultures taken (p=0.001). These patients also received overall more diagnostic and treatment modalities than those that received definitive surgical intervention within 7 days.

CONCLUSIONS: The duration of time patients with diabetes-related foot problems who see orthopedic surgeons for longer periods of time receive more treatment modalities and are referred more often to specialists before transtibial amputation surgery. We believe that delayed presentation is one of the main obstacles prohibiting adequate treatment for these patients.