Van Gils CC, Wheeler LA, Mellstrom M, Brinton EA, Mason S, Wheeler CG, et al.
Diabetes care. Date of publication 1999 May 1;volume 22(5):678-83.
1. Diabetes Care. 1999 May;22(5):678-83.
Amputation prevention by vascular surgery and podiatry collaboration in high-risk
diabetic and nondiabetic patients. The Operation Desert Foot experience.
Van Gils CC(1), Wheeler LA, Mellstrom M, Brinton EA, Mason S, Wheeler CG.
Author information:
(1)Department of Surgery, Veterans Affairs Medical Center, Phoenix, Arizona, USA.
OBJECTIVE: To describe a unique multidisciplinary outpatient intervention for
patients at high risk for lower-extremity amputation.
RESEARCH DESIGN AND METHODS: Patients with foot ulcers and considered to be high
risk for lower-extremity amputation were referred to the High Risk Foot Clinic of
Operation Desert Foot at the Carl T. Hayden Veterans Affairs' Medical Center in
Phoenix, Arizona, where patients received simultaneous vascular surgery and
podiatric triage and treatment. Some 124 patients, consisting of 90 diabetic
patients and 34 nondiabetic patients, were initially seen between 1 October 1991
and 30 September 1992 and followed for subsequent rate of lower-extremity
amputation.
RESULTS: In a mean follow-up period of 55 months (range 3-77), only 18 of 124
patients (15%) required amputation at the level of the thigh or leg. Of the 18
amputees, 17 (94%) had type 2 diabetes. The rate of avoiding limb loss was 86.5%
after 3 years and 83% after 5 years or more. Furthermore, of the 15 amputees
surviving longer than 2 months, only one (7%) had to undergo amputation of the
contralateral limb over the following 12-65 months (mean 35 months). Compared
with nondiabetic patients, patients with diabetes had a 7.68 odds ratio for
amputation (95% CI 5.63-9.74) (P < 0.01).
CONCLUSIONS: A specialized clinic for prevention of lower-extremity amputation is
described. Initial and contralateral amputation rates appear to be far lower in
this population than in previously published reports for similar populations.
Relative to patients without diabetes, patients with diabetes were more than
seven times as likely to have a lower-extremity amputation. These data suggest
that aggressive collaboration of vascular surgery and podiatry can be effective
in preventing lower-extremity amputation in the high-risk population.
PMID: 10332665 [Indexed for MEDLINE]
