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A developing world experience with distal foot amputations for diabetic limb salvage

机译：发展中国家远端肢体截肢治疗糖尿病的经验

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Objectives: To evaluate the functional outcome, morbidity, and viability of foot salvage in diabetic patients.Materials and methods: This prospective case series was conducted from March 2007 to December 2012 at the department of surgery Pakistan Ordnance Factories Hospital, Wah Cantt, Pakistan. 123 males and 26 female patients were included in the study. All the patients were treated after getting admitted in the hospital and wounds were managed with daily dressings, nursing care and debridement of necrotic tissue with adequate antibiotic coverage.Results: In total, 149 patients (mean age: 56±7.52 years) with 171 amputations were included in the study. The mean duration of diabetes mellitus (DM) was 9±4.43 years. Ninety-seven percent of the patients were diagnosed with type 2 DM. Wound debridement was performed under general anesthesia in 48 (33.2%) patients, whereas local anesthesia was used for the rest of the patients after having good glycemic control and improvement in general health. The most common pathogen isolated from the infected wounds was Staphylococcus aureus in approximately 46% cases. Regarding the types of amputation, partial toe amputation was performed in 21 (12.2%) cases, second-toe amputation in 60 (35%) cases, hallux amputation in 41 (24%) cases, multiple toe amputations in 29 (17%) cases, bilateral feet involvement was observed in 16 (9.3%) cases, and transmetatarsal amputation was performed in 4 (2.3%) cases. The wounds healed well except in 19 cases where amputation had to be revised to a more proximal level. Thirty-nine patients died during the study period: 3 died of wound-related complications and 36 died of systemic complications.Conclusion: With the ever-increasing epidemic of DM, the number of patients with diabetic foot ulcers has also significantly risen. Early surgical management with good glycemic control and foot care with close monitoring can decrease amputations and thus foot salvage can be successfully achieved.
机译：目的：评估糖尿病患者足功能抢救的功能结局，发病率和生存能力。材料与方法：该前瞻性病例系列研究于2007年3月至2012年12月在巴基斯坦瓦赫特市巴基斯坦兵工厂医院外科进行。这项研究包括123名男性和26名女性患者。所有患者入院后均接受了治疗，并通过每日敷料，护理和坏死组织清创术进行了伤口处理，并覆盖了足够的抗生素。结果：总共149例患者（平均年龄：56±7.52岁）被截肢了171例被纳入研究。糖尿病的平均持续时间为9±4.43年。 97％的患者被诊断出患有2型DM。 48例（33.2％）患者在全身麻醉下进行伤口清创，而其余的患者在良好的血糖控制和整体健康状况改善后使用局部麻醉。从感染伤口中分离出的最常见病原体是金黄色葡萄球菌，约占46％。在截肢类型上，部分脚趾截肢21例（12.2％），二次脚趾截肢60例（35 %%），拇趾截肢41例（24％），多趾截肢29例（ 17％）病例，双侧脚受累16例（9.3％），经trans骨截肢4例（2.3％）。伤口愈合良好，但有19例必须将截肢矫正至更近端的水平。在研究期间死亡39例：3例因伤口相关的并发症死亡，36例因系统性并发症死亡。结论：随着DM的不断流行，糖尿病足溃疡的患者人数也显着增加。早期的外科手术治疗具有良好的血糖控制和密切监测的足部护理，可以减少截肢，从而可以成功地进行足部抢救。

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