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Surgical Treatment and Prognostic Factors of the Diabetic Foot Akeo Waseda 1 , Norio Usami 2 , Suguru Inokuchi 3 , Tohru Hoshino 3 , Eiichi Hiraishi 3 , Masaki Miyanaga 3 , Norio Mizutani 3 , Takumi Yoshino 3 , Chisato Shimamura 3 1Department of Orthopaedic Surgery, International Goodwill Hospital 2Department of Orthopaedic. Surgery, Shiseikai 2nd Hospital Keyword: diabetic foot , 糖尿病足 , surgical treatment , 外科的治療 , prognosis , 予後 pp.195-200
Published Date 2004/2/1
DOI https://doi.org/10.11477/mf.1408100375
  • Abstract
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 We evaluated prognostic factors in eighty-five feet of fifty-eight patients after surgical treatment for diabetic gangrene. Complications, amputation level, and prognosis were investigated in regard to forty-eight patients (sixty-one feet), twenty-six of whom were alive at the time of the final investigation and twenty-two of whom had died. Complications included peripheral arterial occlusive disease (PAD) in sixteen patients, cerebral infarction (CI) in twelve, and ischemic heart disease (IHD) in twelve.

 The average follow-up period of the survivors was 3 years ten months, and the average postoperative survival time of the patients who had died was 4 years. The final operations and/or amputation levels were:curettage or skin transplantations in 3 feet, toe amputations in twenty-eight feet, foot amputation in 4 feet, below knee (BK) amputation in twenty-one feet, and above knee (AK) amputation in 5 feet.

 The correlations between the amputation levels and complications showed that the amputation level in the patients with PAD was higher than in the patients without PAD. The postoperative survival time of the patients with IHD and/or CI was shorter than that of the patients without IHD and/or CI.

 The 3-year postoperative mortality rate of the patients in whom the amputation was performed at the BK or higher level was 57%, versus 33%among the patients in whom the amputation was performed at the foot or the toe level.

 These results suggest that QOL should be taken into consideration when deciding on the amputation level in patients whose general condition is poor.


Copyright © 2004, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1286 印刷版ISSN 0557-0433 医学書院

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