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Non-Traumatic Lower Extremity Amputation (The Common Causes)………………………………………. | ||
| Kerbala Journal of Medicine | ||
| Article 1, Volume 2, Issue 4, 2009, Pages 479-485 PDF (0 K) | ||
| Author | ||
| Dr. Mahdi A. Abdul Hussein | ||
| Abstract | ||
| objective: Lower Extremity Amputation (LEA): is defined as the complete loss in the transverse plane of any part of the lower limb, and categorized as(1): (1) Minor (i.e. at or below the ankle joint). (2) Major (i.e. above the ankle joint). Method & patients:The aim of this study is to determine the common causes of non-traumatic L.E.A. It is a retrospective study of (138) patients, with 149 lower limbs treated by amputation for different causes in Al-Hussein general and Al-Abass private hospitals in Karbala, in the period between Sep, 2002 through Sep, 2007, excluding cases due to trauma, military and army attacks. Results: Diabetes is a major risk factor for LEA and form (78.5 %) of cases with different presentations. The important risk factors were infected deep ulcer in neuropathic foot (26 cases), late stages of infected foot (38 cases) and arteriosclerosis (51 cases) presented as gangrene in one toe or more. Patients with loss of protective sensation, loss of education and preventive program and neglect the ulcer or mild injury to complicate and presented in late stages end with amputation. Non-diabetic peripheral vascular disease (17%) is the 2nd cause; it is either arteriosclerosis or Beurger disease. Other rare causes were primary malignant bone tumor (3%) and other miscellaneous causes such as non-diabetic chronic osteomylitis (1.5%). Minor amputations were 61 limbs (i.e.41%) but major amputations were 88limbs (59 %). (19) Patients from diabetic group had history of previous major amputations in the same side or other limb, and (11) of them done during the study period, so considered as risk factor. Conclusion:Diabetic foot is the most common cause of LEA, and reduction in the number of amputation can be achieved if the patient is directed to foot-care programs. The diabetics need comprehensive care, included good endocrine control, education on endocrine control, yearly foot screening by multidisciplinary foot-care team. The patients should instructed to pay meticulous attention to foot wear, foot hygiene, to cutting nail and daily foot inspection to reducing the risk of an injury that can lead to heel ulcer and amputation. | ||
| Keywords | ||
| Lower extremity amputation; Diabetes; peripheral vascular disease; foot ulcer; gangrene; peripheral neuropathy and infection | ||
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