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The Outcome of Surgical Treatment for the Neuropathic Diabetic Foot Lesions—A Single-Center Study

The prevalence of diabetic foot complications is continuously increasing as diabetes has become one of the most important “epidemics” of our time. The main objective of this study was to describe the appropriate surgical intervention for the complicated neuropathic diabetic foot; the secondary goal...

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Detalles Bibliográficos
Autores principales: Bobirca, Florin, Smarandache, Catalin Gabriel, Bobirca, Anca, Alexandru, Cristina, Dumitrescu, Dan, Stoian, Anca Pantea, Bica, Cristina, Brinduse, Lacramioara Aurelia, Musetescu, Anca, Gheoca-Mutu, Daniela-Elena, Isac, Sebastian, Ancuta, Ioan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9409874/
https://www.ncbi.nlm.nih.gov/pubmed/36013336
http://dx.doi.org/10.3390/life12081156
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author Bobirca, Florin
Smarandache, Catalin Gabriel
Bobirca, Anca
Alexandru, Cristina
Dumitrescu, Dan
Stoian, Anca Pantea
Bica, Cristina
Brinduse, Lacramioara Aurelia
Musetescu, Anca
Gheoca-Mutu, Daniela-Elena
Isac, Sebastian
Ancuta, Ioan
author_facet Bobirca, Florin
Smarandache, Catalin Gabriel
Bobirca, Anca
Alexandru, Cristina
Dumitrescu, Dan
Stoian, Anca Pantea
Bica, Cristina
Brinduse, Lacramioara Aurelia
Musetescu, Anca
Gheoca-Mutu, Daniela-Elena
Isac, Sebastian
Ancuta, Ioan
author_sort Bobirca, Florin
collection PubMed
description The prevalence of diabetic foot complications is continuously increasing as diabetes has become one of the most important “epidemics” of our time. The main objective of this study was to describe the appropriate surgical intervention for the complicated neuropathic diabetic foot; the secondary goal was to find the risk factors associated with minor/major amputation and good or adverse surgical outcomes. This is an observational, retrospective study conducted between 1 January 2018 and 31 December 2019, which included 251 patients from the General Surgery Department at the Dr I. Cantacuzino Clinical Hospital in Bucharest with type II diabetes mellitus and neuropathic diabetic foot complications. The surgical conditions identified at admission were the following: osteitis (38.6%), infected foot ulcer (27.5%), gangrene (20.7%), infected Charcot foot (3.6%), non-healing wound (3.6%), necrosis (3.2%), and granulated wound (2.8%). We found that a minor surgical procedure (transmetatarsal amputation of the toe and debridement) was performed in 85.8% of cases, and only 14.2% needed major amputations. Osteitis was mainly associated with minor surgery (p = 0.001), while the gangrene and the infected Charcot foot were predictable for major amputation, with OR = 2.230, 95% CI (1.024–4.857) and OR = 5.316, 95% CI (1.354–20.877), respectively. Admission anemia and diabetic nephropathy were predictive of a major therapeutical approach, with p = 0.011, OR = 2.975, 95% CI (1.244–8.116) and p = 0.001, OR = 3.565, 95% CI (1.623–7.832), respectively. All the major amputations had a good outcome, while only several minor surgeries were interpreted as the adverse outcome (n = 24). Osteitis (45.8%) and admission anemia (79.2%) were more frequently associated with adverse outcomes, with p = 0.447 and p = 0.054, respectively. The complicated neuropathic diabetic foot requires a surgical procedure mainly associated with a good outcome.
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spelling pubmed-94098742022-08-26 The Outcome of Surgical Treatment for the Neuropathic Diabetic Foot Lesions—A Single-Center Study Bobirca, Florin Smarandache, Catalin Gabriel Bobirca, Anca Alexandru, Cristina Dumitrescu, Dan Stoian, Anca Pantea Bica, Cristina Brinduse, Lacramioara Aurelia Musetescu, Anca Gheoca-Mutu, Daniela-Elena Isac, Sebastian Ancuta, Ioan Life (Basel) Article The prevalence of diabetic foot complications is continuously increasing as diabetes has become one of the most important “epidemics” of our time. The main objective of this study was to describe the appropriate surgical intervention for the complicated neuropathic diabetic foot; the secondary goal was to find the risk factors associated with minor/major amputation and good or adverse surgical outcomes. This is an observational, retrospective study conducted between 1 January 2018 and 31 December 2019, which included 251 patients from the General Surgery Department at the Dr I. Cantacuzino Clinical Hospital in Bucharest with type II diabetes mellitus and neuropathic diabetic foot complications. The surgical conditions identified at admission were the following: osteitis (38.6%), infected foot ulcer (27.5%), gangrene (20.7%), infected Charcot foot (3.6%), non-healing wound (3.6%), necrosis (3.2%), and granulated wound (2.8%). We found that a minor surgical procedure (transmetatarsal amputation of the toe and debridement) was performed in 85.8% of cases, and only 14.2% needed major amputations. Osteitis was mainly associated with minor surgery (p = 0.001), while the gangrene and the infected Charcot foot were predictable for major amputation, with OR = 2.230, 95% CI (1.024–4.857) and OR = 5.316, 95% CI (1.354–20.877), respectively. Admission anemia and diabetic nephropathy were predictive of a major therapeutical approach, with p = 0.011, OR = 2.975, 95% CI (1.244–8.116) and p = 0.001, OR = 3.565, 95% CI (1.623–7.832), respectively. All the major amputations had a good outcome, while only several minor surgeries were interpreted as the adverse outcome (n = 24). Osteitis (45.8%) and admission anemia (79.2%) were more frequently associated with adverse outcomes, with p = 0.447 and p = 0.054, respectively. The complicated neuropathic diabetic foot requires a surgical procedure mainly associated with a good outcome. MDPI 2022-07-29 /pmc/articles/PMC9409874/ /pubmed/36013336 http://dx.doi.org/10.3390/life12081156 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Bobirca, Florin
Smarandache, Catalin Gabriel
Bobirca, Anca
Alexandru, Cristina
Dumitrescu, Dan
Stoian, Anca Pantea
Bica, Cristina
Brinduse, Lacramioara Aurelia
Musetescu, Anca
Gheoca-Mutu, Daniela-Elena
Isac, Sebastian
Ancuta, Ioan
The Outcome of Surgical Treatment for the Neuropathic Diabetic Foot Lesions—A Single-Center Study
title The Outcome of Surgical Treatment for the Neuropathic Diabetic Foot Lesions—A Single-Center Study
title_full The Outcome of Surgical Treatment for the Neuropathic Diabetic Foot Lesions—A Single-Center Study
title_fullStr The Outcome of Surgical Treatment for the Neuropathic Diabetic Foot Lesions—A Single-Center Study
title_full_unstemmed The Outcome of Surgical Treatment for the Neuropathic Diabetic Foot Lesions—A Single-Center Study
title_short The Outcome of Surgical Treatment for the Neuropathic Diabetic Foot Lesions—A Single-Center Study
title_sort outcome of surgical treatment for the neuropathic diabetic foot lesions—a single-center study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9409874/
https://www.ncbi.nlm.nih.gov/pubmed/36013336
http://dx.doi.org/10.3390/life12081156
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