• Vascular Specialist International
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• 제34권4호
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• pp.109-116
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• 2018

Purpose: Diabetic foot wound (DFW) is known as a major contributor of nontraumatic lower extremity amputation. We aimed to evaluate overall amputation rates and risk factors for amputation in patients with DFW. Materials and Methods: From January 2014 to December 2017, 141 patients with DFW were enrolled. We determined rates and risk factors of major amputation in DFW and in DFW with peripheral arterial occlusive disease (PAOD). In addition, we investigated rates and predictors for amputation in diabetic foot ulcer (DFU). Results: The overall rate of major amputation was 26.2% in patients with DFW. Among 141 DFWs, 76 patients (53.9%) had PAOD and 29 patients (38.2%) of 76 DFWs with PAOD underwent major amputation. Wound state according to Wagner classification, congestive heart failure, leukocytosis, dementia, and PAOD were the significant risk factors for major amputation. In DFW with PAOD, Wagner classification grades and leukocytosis were the predictors for major amputation. In addition, amputation was performed for 28 patients (38.4%) while major amputation was performed for 5 patients (6.8%) of 73 DFUs. Only the presence of osteomyelitis (OM) showed significant difference for amputation in DFU. Conclusion: This study represented that approximately a quarter of DFWs underwent major amputation. Moreover, over half of DFW patients had PAOD and about 38.2% of them underwent major amputation. Wound state and PAOD was major predictors for major amputation in DFW. Systemic factors, such as CHF, leukocytosis, and dementia were identified as risk factors for major amputation. In terms of DFU, 38.4% underwent amputation and the presence of OM was a determinant for amputation.

• 대한족부족관절학회지
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• 제16권4호
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• pp.257-264
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• 2012

Purpose: The diabetic foot lesions are intractable, and aggravation often leads to amputation. None or minor amputation group was treated debridement or toe amputation and major amputation group was treated Ray, Lisfranc, Chopart, Below Knee and Above Knee amputation. We investigate the risk factors for major limb amputations among patients with diabetic foot lesion. Materials and Methods: The subjects were 73 diabetic foot lesion patients (83 diabetic foot lesions) treated at our department from January 2006 to December 2010. Non or Minor amputation group of 44 cases were treated with debridement or toe amputation. Major amputation group of 39 cases were treated with Ray, Lisfranc, Chopart, below or above Knee amputation. We investigated socioeconomic factors, diabetes mellitus related factors and wound related factors and laboratory factors. Statistical analysis was done by Students t-test, Chi-square test, Mann-Whitney's U test. Results: In our analysis, wound size, wound classification (Wagner classification, Brodsky classification), white blood cell counts, polymorphoneuclear neutrophil percentage, hemoglobin, C-reactive protein and albumin were risk factors for major amputation (p<0.05). Conclusion: Low education level, nutritional condition, premorbid activity level and progressed wound condition were observed in major amputation group compared with non or minor amputation group. In the major amputation group, higher white blood cell count, C-reactive protein level and lower albumin level were observed. Together with maintenance of adequate nutritional condition, early detection of lesions and foot care for early treatment is important. Therefore, active investigation with full risk evaluation of vascular complication is also important.

• Journal of Trauma and Injury
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• 제29권4호
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• pp.187-190
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• 2016

With the development of safety measures for employees who work with dangerous machinery, the frequency of amputation injuries has been decreasing with resultant decrease in replantation procedures. However, in some patients with major amputation injury, replantation is still necessary for the preservation of limb and it's function. The replantation of the upper extremity (UE) is a complex and technically demanding surgical procedure. For the successful replantation of UE, the type of injury, reconstruction sequence, ischemic time, and other combined injury of patient should be considered. We report a case of major amputation of UE by guillotine-type injury and discuss the treatment process of this patient.

• 대한족부족관절학회지
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• 제13권1호
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• pp.50-54
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• 2009

Purpose: The authors evaluated the clinical results and prognosis after amputating the lower extremity due to diabetic foot. Materials and Methods: From 1991 to 2003, the patients who had suffered amputation of his lower extremity due to diabetic foot ulcer were evaluated retrospectively. 79 patients were male and 6 patients were female. The author evaluated the patient who had the ipsilateral additional surgery, contralateral amputation, level of blood sugar, combined disease and mortality rate within 5 years from medical record. Statistical analysis was done by Chi-square test and Kaplan-Meier survival test. Results: Mean age of patients who had first experienced amputation was 63.4 years old. The mean duration of diabetes until amputation was $14.5{\pm}7.5$ years. Major amputations were 50 cases and minor amputations 35 cases. 20 patients (23.5%) were suffered ipsilateral secondary surgery including revised stump. Overall 5-year mortality rate was 18.8% (16 cases). Death rate within 1 year was 8.2% (7 cases), mortality rate within 3 years was 14.1% (12 cases). 5-year mortality rate after major amputation was 20% (10 cases) and after minor amputation was 17.1% (6 cases). It was statistically significant (p<0.05). Patient who underwent more than 2 combined vascular related disease had higher mortality rate than diabetic amputee without combined disease (p<0.05). Conclusion: Mortality rate after major amputation was significant higher than amputation after minor amputation in diabetic patients from our data.

• 대한족부족관절학회지
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• 제20권3호
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• pp.121-125
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• 2016

Purpose: This study investigates the amputation rate within 1 year after the diagnosis of diabetic foot ulcer and its associated risk factors. Materials and Methods: This study enrolled 60 patients with diabetic foot ulcer. The mean and standard deviation age was $64.4{\pm}12.8years$ (range, 32~89 years); the mean and standard deviation prevalence period for diabetes mellitus was $21.0{\pm}7.5years$ (range, 0.5~36 years). The amputation rate was evaluated by dividing the subjects into two groups - the major and minor amputation groups - within 1 year following the initial diagnosis of diabetic foot ulcer. Multivariate Cox proportional hazards regression analysis was used to identify the risk factors for amputation. Results: The total amputation rate of 38.3% (n=23) was comprised of the amputation rate for the major amputation group (10.0%) and rate for the minor amputation group (23.8%). There was a high correlation between peripheral artery disease (toe brachial pressure index <0.7) and amputation (hazard ratio [HR] 5.81, confidence interval [CI] 2.09~16.1, p<0.01). Nephropathy was significantly correlated with the amputation rate (HR 3.53, CI 1.29~9.64, p=0.01). Conclusion: Clinicians who treat patients with diabetic foot complications must understand the fact that the amputation rate within 1 year is significant, and that the amputation rate of patients with peripheral artery disease or nephropathy is especially high.

• 대한족부족관절학회지
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• 제17권1호
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• pp.52-59
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• 2013

Purpose: The purpose of this study is to evaluate treatment results of multidisciplinary approach of critical ischemic limb with diabetic foot. Materials and Methods: From March 2005 to March 2012, 674 diabetic foot patients were analyzed. Among them, 85 patients were neuroarthropathic type, 383 patients were infectious type, and 206 patients were ischemic type. The subjects were 206 patients who had critical ischemic limbs and major or minor amputations were done. Various single or combined treatment method before amputation was performed. We investigated their ABI, HbA1c, main occlusion lesion, limb salvage and hospitalization period by various treatment method. Results: Major amputation was 27 cases, minor amputation was 179 cases. Mean HbA1c was 8.2%, and mean ABI was 0.66. Main occlusion lesion was 6 cases at common iliac artery, 13 cases at external iliac artery, 9 cases at internal iliac artery, 11 cases at common femoral artery, 23 cases at deep femoral artery, 52 cases at superficial femoral artery, 35 cases at popliteal artery, 40 cases at posterior tibia artery, 35 cases at anterior tibial artery, 28 cases at peroneal artery, and 13 cases at dorsalis pedis artery. Major amputations were decreased, minor amputations were increased, and hospitalization period was reduced by treatment of multidisciplinary approach. Conclusion: Treatment of multidisciplinary approach, which include preoperation percutaneus transluminal angioplasty, vascular surgery, and amputation, of critical ischemic limb with diabetic foot had advantages of limb salvage and hospitalization period reduction.

• 대한족부족관절학회지
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• 제11권2호
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• pp.216-220
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• 2007

Purpose: To evaluate the effectiveness of percutaneous transluminal angioplasty (PTA) below the knee as a treatment in diabetic foot gangrene. Materials and Methods: Between May 2003 and May 2006, angiography was performed in 35 diabetic foot gangrene classified as either Wagner grade IV or V. Infrapopliteal PTA was performed in 10 patients among them. Clinical success was defined as prevention of major amputation. Results: Among 25 patients who did not receive infrapopliteal PTA, the major amputation rate is 22% (in one arterial occlusion cases), 50% (in two arterial occlusion cases), 63% (in three arterial occlusion cases), respectively. Infrapopliteal PTA was successfully performed in 8 among 10 patients. Two patients were failed and undergone below-knee amputation. Toe amputation were performed in 2 patients with one arterial occlusion. Out of 6 patients with three arterial occlusions, toe amputations were performed in 4 patients and the other 2 patients were healed through debridement. Conclusion: As a first choice revascularization procedure for limb salvage in diabetic foot gangrene, infrapopliteal PTA can be one of treatment options.

• 대한족부족관절학회지
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• 제7권1호
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• pp.83-87
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• 2003

Purpose: To evaluate the factors which affect the level of the amputation for treatment of DM foot excluding arterial occlusion. Materials and Methods: We selected 30 patients (10 of major amputations, 20 of minor amputations) who were amputated from May, 1999 to April, 2001 because of DM foot. Major amputation is BK amputation, and minor amputation is amputation below ankle joint. Gender, age, size of the wound, extent of the necrosis, infectious organism, medical com orbidity, duration of DM and blood glucose level, duration of DM foot and treatment history were investigated. Results: In major amputations, male to female ratio was 9:1, average of the age was 63.8, the average of sizes of the wound was 16cm2, duration of DM was 15.0 years, duration of DM foot was 10.6 weeks, and 80% of patients had necrosis and the organisms were S. aureus, E. faecium, Streptococcus, P. vulgaris, average of the blood glucose levels was 301 and 40% of them had been treated for DM foot. In minor amputations, male to female ration was 9:1, average of the age was 56.6, the average of sizes of the wound was 4.8cm2, duration of DM was 11.2 years, duration of DM foot was 5.7 weeks, and 40% of patients had necrosis and the organisms were S. aureus, Streptococcus, M. morganini, E. faecium, average of the blood glucose levels was 257 and 20% of them had been treated for DM foot. Conclusion: In DM foot patients, extents of the necrosis, duration of DM, duration of DM foot, the infectious organism were significant factors to decide extent of the amputation level.

• PNF and Movement
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• 제17권1호
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• pp.11-18
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• 2019

Purpose: This study verifies the muscle activity around the amputation site during proprioceptive neuromuscular facilitation (PNF) pattern exercise for the upper extremities on the non-amputated part in upper extremity amputees and provides basic data on effective exercise around an amputation site. Methods: Manual resistance was applied to the PNF upper extremity pattern of the non-amputated part to generate muscle activity around the amputation site. The resistance was adjusted to an intensity that could cause maximal isometric contraction. The muscle activity of the amputation site and the non-amputated part was measured using a surface electromyogram for the upper trapezius, middle trapezius, infraspinatus, serratus anterior, and pectoralis major. Results: During the scapular exercise in the painless range, the amputated side showed significantly lower muscle activity and a lower muscle contraction ratio compared with the non-amputated side. During the PNF pattern exercise in the painless range, the amputated side showed lower muscle activity and a lower muscle contraction ratio compared with the non-amputated side. When the direct scapular exercise of the amputated side was compared with the PNF pattern exercise of the non-amputated side, their muscle contraction ratios were similar. Conclusion: This study confirmed the effectiveness of the PNF pattern exercise of the non-amputated part as a way to indirectly train the injured site with no pain for rehabilitation of patients with serious body injuries, such as amputation. It is necessary to develop effective exercise programs for the rehabilitation of the amputation site based on the results of this study.

• 대한족부족관절학회지
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• 제10권1호
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• pp.1-6
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• 2006

Purpose: To evaluate the clinical manifestations, the patterns and the functional outcome of the amputations due to the diabetic foot complications. Materials and Methods: Fifty patients (50 feet) of diabetic foot amputations were followed for more than 1 year. The mean age was 62.5 years, and the mean follow-up period was 46 months. Retrospective analysis was performed using chart review and interview with the patients. The outcome was assessed with modified AOFAS scale. Results: The diabetic foot lesions were infection in 45 feet, gangrene in 35 feet and ulcer in 15 feet. Toe amputation was most commonly performed procedure (23 cases) followed by below knee and ray amputation. Postoperative modified AOFAS score was average 51.5 points, and 94% were satisfied with outcome. Minor amputations showed better outcome than the major amputations. Conclusion: Overall postoperative functional outcome was encouraging with high patient satisfaction rate (94%). Better outcome was obtained with the minor amputations.