Approach to Managing Diabetic Foot Complications. A Study of 200 Cases

Objective: Diabetic foot complications result mostly from uncontrolled diabetes and it has become an increasingly significant public health concern in both developed and developing world. The aim of this study was to evaluate the surgical management in diabetic foot patients presenting with different complications. Design: A descriptive study. Place & Duration of Study: From April 2007 to March 2008 for a period of one year in Surgical unit I at DHQ Hospital Sargodha. Patients & Methods: This descriptive study was conducted on a total of 200 diabetic patients with different severity of foot infections who presented in causality and surgical outpatient department in DHQ Hospital Sargodha. Patients under the age of twelve years were excluded from this study; it included patients of both sexes. A detailed history was taken followed by the clinical examination. Routine investigations including complete blood examination, complete urine examination, renal parameters, X ray foot, CXR, ECG and pus for culture and sensitivity were recorded. Lesions were graded according to Maggit Wagner classification and appropriate medical and surgical treatment was carried out. Results: This study was carried out on 200 diabetic patients, out of which one hundred and sixty (80.0%) were male and forty (20%) were female. Male to female ratio was 4:1 Majority of the patients (n=116) were between the age group of 50 to 60 years. In majority of these patients forefoot was involved, mostly big or little toe. Patients were grouped into five grades according to the severity of infection. Forty three (21.5%) patients were managed with antibiotics and dressings, ninety seven (48.5%) patients needed debriedment and skin grafting while sixty (30.0%) needed amputations of different types. Staphylococcus aureus was the commonest organism isolated. Conclusion: There is a high occurrence of foot ulcers with in the population of people with diabetes. Majority of the diabetic foot lesions in our study were in grade II to V. lesser grade lesions responded well to conservative management with antibiotics, dressings and debriedment. While those with higher grades needed amputations. In order to diminish the detrimental consequences associated with diabetic foot, a high standard of care must be provided. Delayed and improper treatment leads to osteomyelitis resulting in amputation and permanent disability or deformity.