P17
Risk factors for unsuccessful healing after minor amputation in patients with diabetic foot
Bém R., Jirkovská A., Fejfarová V., Skibová J., Sixta B.
Institute for Clinical and Experimental Medicine, Diabetes Centre, Prague, Czech Republic
Background and Aims: Many risk factors for foot ulcers and amputations were studied, but there is a lack of studies dealing with factors for difficult healing after minor amputation. Aim of our study was to assess risk factors for unsuccessful wound healing after minor amputation in patients with diabetic foot.
Material and Methods: We evaluated 128 patients (mean age 69±12 years, 87.5% Type 2 diabetes) treated in our foot clinic and indicated for minor amputation during the period 4/2000- 7/2003. The main reason for amputation was osteomyelitis in 115/128 (90%) of patients. The healing was evaluated after 6 months since primary amputation. Criterion for successful healing after the amputation was healed wound below the metatarsal level; unsuccessful healing was assessed as non-healed wound or reamputation above the ankle. Potentional risk factors for unsuccessful healing were selected from risk factors for foot ulcers and amputations, known from previous studies. We evaluated those factors- type of diabetes, diabetes duration, diabetes control measured by glycosylated haemoglobin (HbA1C), presence of ischemic heart disease and cerebral ischemia, severe diabetic polyneuropathy measured by biothesiometer, peripheral arterial disease assessed by transcutaneous oxygen tension (TcpO2) and laboratory blood parameters of infection- C-reactive protein (CRP) and white blood cells count. Potentional risk factors were assessed before the amputation. Stepwise logistic regression was used to determine which of the factor(s) are associated with the unsuccessful healing after minor amputation.
Results: Unsuccessful healing was seen in 29/128 (22.7%) of patients - 10 (7.8%) of them were healed above the ankle and 19 (14.9%) patients were non-healed during the study period. Stepwise logistic regression has shown that low value of TcpO2 (Odds ratio [OR] = 0.653, 95% CI 0.50-0.853), high value of CRP (OR = 1.07, 95% CI 1.02-1.13) and presence of cerebral ischemia in history (OR = 0.036, 95% CI 0.001-1.08) are significant risk factors for unsuccessful healing after minor amputation in patients with diabetic foot; other assessed potential risk factors were no significant.
Conclusion: The results of our study support the premise that measurement of transcutaneous oxygen tension and CRP before minor amputation is helpful in predicting the prognosis of wound healing after minor amputation; aggressive therapy of infection and ischaemia before minor amputation is necessesary for improve the prognosis of wound healing.
This study was supported by the IKEM (MZO 00023001).