Progression of Diabetic Foot Ulcers To Lower Limb Amputations: A Retrospective Analysis

Wasim Hayat Khan, Ammara Zia-ul-Mustafa, Adeel Ahmad, Noor Hajrah, Sharjeel Mahmood, Umer Shehroz Khan

Abstract

Objective

To determine the frequency and perforated risk factor analysis of progression of diabetic foot ulcer (DFU) to lower limb amputation in a tertiary care teaching hospital.

Study design

Retrospective observational study.

Place & Duration of study

Department of General Surgery, East Surgical Ward, Mayo Hospital / Kind Edward Medical University Lahore, from January 2024 to January 2025.

MethodsRecords of 134 adult patients admitted with DFU were reviewed. Data collected included demographic variables, glycemic control (HbA1c), co-morbid conditions, characteristics of the ulcer (site, size, Wagner grade), severity of infection by International Working Group on the Diabetic Foot / Infectious Diseases Society of America (IWGDF/IDSA) criteria, presence of peripheral arterial disease (PAD), ulcer duration before presentation, and outcomes. Associations with amputation were analyzed using Chi-square test. A p-value of <0.05 was taken as significant.

Results

This study included 102 males and 32 females. A total of 101 (75.4%) patients underwent  amputation. Amputation was done in 69 (67.6%) out of total 102 males and all  the  female  patients. The mean size of  the ulcer  was 10.8 ± 11.3 cm².  According to the  Wagner grade most of the patients were of Grade-4 (n=41 - 40.2%) and Grade-5 (n=46 - 45.1%). Significant associations with amputation was found with higher Wagner grade (p < 0.001), severe infection (p=0.048), chronic kidney disease (p=0.019), and peripheral neuropathy (p=0.041). Other variables like HbA1c status were not found statistically significant.

Conclusion

A high proportion of patients admitted with DFU required amputation. Majority of them presented late with advanced Wagner grade and severe infection.  

Key words

Diabetic foot ulcer, Lower-extremity amputation (LEA), Wagner classification, Peripheral arterial disease.