Redefined clinical spectra of diabetic foot syndrome
Received 30 March 2018
Accepted for publication 17 August 2018
Published 18 October 2018 Volume 2018:14 Pages 291—298
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 2
Editor who approved publication: Professor Daniel Duprez
Nawaf J Shatnawi,1 Nabil A Al-Zoubi,1 Hasan Hawamdeh,2 Yousef S Khader,3 Abd El-Karim Omari,1 Muhammad R Khammash1
1Department of Surgery, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Basic Medical Science, Faculty of Medicine, Hashemite University, Zarqa, Jordan; 3Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan
Purpose: The aim of this study was to present the redefined clinical spectra of diabetic foot syndrome (RCS-DFS) and determine whether the RCS-DFS can be used to predict amputations.
Patients and methods: This is a retrospective study of type 2 diabetic patients referred with DFS for management at King Abdullah University Hospital (KAUH) between January 2014 and December 2015. Data collection form and diabetic foot (DF) characteristic chart were used to document the following: demographic data, diabetes-related parameters, DF characteristics, surgical interventions and amputations. The predominant clinical presentations of DF problems (ulcer, sepsis or gangrene) were integrated with the clinical criteria for diabetic foot infection (DFI) diagnosis and classification of Infectious Diseases Association of America (IDSA)/International Working Group on Diabetic Foot (IWGDF) to redefine the clinical spectra of DFS. Related risk characteristics and amputation rate at all levels were compared between the three RCS.
Results: In this study, there were 95 (47.0%) septic DFS (SDFS) patients, 65 (32.2%) ulcerative DFS (UDFS) patients and 42 (20.8%) gangrenous DFS (GDFS) patients. Poor glycemic control (HbA1c >7.5%), hypertension, history of the same foot problems, duration of symptoms, revascularizations and ischemic severity were significantly different between the three RCS. UDFS had the highest rate of limb salvage without amputations (70.8%). GDFS had the highest rate for final toe amputations (52.4%) and major amputations (23.8%). Final minor amputation rate was around 20% for both SDFS and GDFS.
Conclusion: Redefining DFS into ulcerative, septic and gangrenous by integration of the predominant clinical presentation and the clinical criteria for DFI diagnosis and classification of IDSA/IWGDF showed significant differences in amputation rate. Therefore, it can be used clinically to categorize patients with DFS to predict amputations and to help in planning their management. Further prospective studies are suggested to validate these results.
Keywords: diabetes mellitus, classification, diabetic foot syndrome, amputations
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