Diabetic Foot Complications During Diasters

NewsBot · Dec 2, 2019

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Diabetic foot and disaster; risk factors for amputation during the Syrian crisis
Abdul Razzak AbdulAzizaMhd BelalAlsabekbc
Journal of Diabetes and its Complications; 26 November 2019, 107493

Highlights
•Full standard management of diabetic foot ulcer shouldn't be interrupted in disaster times.
•Team and staff of NGO(s) in crisis should be trained on the diabetic foot wound special requirements.
•Peripheral artery disease, infection, and heel ulcers are still the main relative risks of amputation.
•Tissue loss from war injuries of the diabetic foot needs full evaluation and closed follow-up.
•Wagner- Meggitt's Classification is simple and valuable in predicting amputation in disaster areas.
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Background
Diabetic foot patients in Syria faced many challenges and difficulties during the recent long term crisis that has prevailed since 2011. This study establishes the risk factors of diabetic foot amputation, either minor or major amputation. It also suggests facilities to improve diabetic foot care in the disaster.

Methods
This is a retrospective study that reviewed diabetic foot outpatients' charts between Jan 2012 and Dec 2017 in Diabetic Foot Clinic in Damascus Teaching Hospital, Syria. We classified the lesions according to the final outcome into: non-amputation, minor and major amputation. We predicted the independent risk factors of lower extremity amputation (LEA).

Results
A total of 2317 diabetic patients visited our clinic regularly with 2722 diabetic foot symptoms. We studied 2006 lesions belong to 1630 diabetic foot patients. They were divided into: group A (outcome without amputation, n = 1372), group B (outcome with minor amputation, n = 528) and group C (final outcome with major amputation, n = 106). Males were slightly predominant (56.73%; n = 1138), but with clearly higher risk of major amputation (6.77%; n = 77). 15.10% of patients was older than 70 years, with no significant relationship between age and amputation risk. According to Meggitt-Wagner classification system, the major amputation rate was (5.28%) in the lesions grade 1 through 5, it went up to (56.74) in isolated grade 5 lesions.

The study recorded a degree of infection in (41.92%; n = 841) of the cases. The amputation rate went up in this group of patients to 53.63% and 8.44% for minor and major amputation, respectively. The presence of peripheral occlusive artery disease (PAD) doubled the minor amputation incidence one time (43.86%), and major amputation incidence five times (15.20%). The heel ulcer showed a great tendency toward the major amputation (18.80%), while the incidence rate in the DFUs spared heel was (3.36%). The war injuries of the diabetic foot was followed up in three cases that were treated conservatively and didn't considered an independent risk factor for amputation as long as the standard care was applied.

Conclusion
This article is the first one that discussed the reality of the diabetic foot care in disasters. It figures out that diabetic foot patients are obviously at higher risk of neglect during the crisis. In the absence of early detecting of wounds, deformities and PAD, DFUs likely come to the podiatrists in advanced stages. The unhealthy environment drives DFUs toward injuries, cellulites and infection. Non-Governmental Organizations (NGOs) and local institutions that work in crisis areas should pay attention for special care requirements of diabetic foot patients, for the standard care of the diabetic foot and the regular follow-up till the healing eventually.
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DaVinci · Dec 2, 2019

Can't say this is a topic that I have ever come across before nor ever given any thought to. Obviously a very important issue.

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DaVinci Well-Known Member

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