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Revascularization Surgery

Its Efficacy for Limb Salvage in Diabetic Foot

Chang, Tzu-Yen MD; Shieh, Shyh-Jou MD, PhD

doi: 10.1097/SAP.0000000000000698
Clinical Papers
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The estimated prevalence of diabetes is 9.78% in Taiwan. The lifetime risk for patients with diabetes to have foot ulcers might be as high as 25%. About 15% of these patients require major limb amputation because of ischemia and infection. Peripheral artery disease is still a major problem involved in diabetic foot disease and the cause for major amputation despite an increase in the prevalence of revascularization surgery and new revascularization techniques over the past 20 years. We investigated the major limb amputation rates in patients with diabetic foot and critical limb ischemia who had undergone revascularization surgery in our hospital. The records of 42 patients who had undergone revascularization surgery for diabetic foot were retrospectively reviewed. Nineteen patients (45%) required major limb amputation despite revascularization. The affected limbs of only 15 patients (36%) were salvaged. Four patients died soon after surgery because of comorbidities, and another 4 were lost to follow-up. Two patients died from procedure-related sepsis, and overall perioperative mortality was 4.8%. Ten predictive risk factors (duration of diabetes, history of smoking, coronary artery disease, congestive heart failure, cerebral vascular accident, contralateral amputation, end-stage renal disease, fever episode, wound infection severity score, and arterial obstruction level) were included for analysis. Although none was significant, long-duration diabetes (OR: 1.13), end-stage renal disease (OR: 10.02), wound infection (OR: 1.56), and infrapopliteal lesions (OR: 3.00) tended to be unfavorable predictive risk factors of limb amputation. Revascularization surgery is still potentially beneficial for these patients—eg, it decreases the contralateral limb amputation rate by 7.5%—if done early in high-risk patients.

From the *Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; and ‡International Research Center for Wound Repair and Regeneration (iWRR), National Cheng Kung University, Tainan, Taiwan.

Received October 20, 2015, and accepted for publication, after revision October 26, 2015.

Conflicts of interest and sources of funding: none declared.

Reprints: Shyh-Jou Shieh, MD, PhD, Professor and Attending Plastic Surgeon, Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 70403, Taiwan; Director, International Research Center for Wound Repair and Regeneration (iWRR), National Cheng Kung University, 1 University Road, Tainan 70101, Taiwan. E-mail: sjshieh@mail.ncku.edu.tw.

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