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. 2020 Sep 15;11(9):391-399.
doi: 10.4239/wjd.v11.i9.391.

Lower extremity amputations and long-term outcomes in diabetic foot ulcers: A systematic review

Ayeshmanthe Rathnayake  1 , Apoorva Saboo  2 , Usman H Malabu  2 , Henrik Falhammar  3
Affiliations

Lower extremity amputations and long-term outcomes in diabetic foot ulcers: A systematic review

Ayeshmanthe Rathnayake et al. World J Diabetes. .

Abstract

Background: Diabetes mellitus causes a large majority of non-traumatic major and minor amputations globally. Patients with diabetes are clinically complex with a multifactorial association between diabetic foot ulcers (DFU) and subsequent lower extremity amputations (LEA). Few studies show the long-term outcomes within the cohort of DFU-associated LEA.

Aim: To highlight the long-term outcomes of LEA as a result of DFU.

Methods: PubMed/MEDLINE and Google Scholar were searched for key terms, "diabetes", "foot ulcers", "amputations" and "outcomes". Outcomes such as mortality, re-amputation, re-ulceration and functional impact were recorded. Peer-reviewed studies with adult patients who had DFU, subsequent amputation and follow up of at least 1 year were included. Non-English language articles or studies involving children were excluded.

Results: A total of 22 publications with a total of 2334 patients were selected against the inclusion criteria for review. The weighted mean of re-amputation was 20.14%, 29.63% and 45.72% at 1, 3 and 5 years respectively. The weighted mean of mortality at 1, 3 and 5 years were 13.62%, 30.25% and 50.55% respectively with significantly higher rates associated with major amputation, re-amputation and ischemic cardiomyopathy.

Conclusion: Previous LEA, level of the LEA and patient comorbidities were significant risk factors contributing to re-ulceration, re-amputation, mortality and depreciated functional status.

Keywords: Diabetes; Diabetic foot ulcers; Long-term outcomes; Lower extremity amputations; Quality of life; Re-amputation.

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Conflict of interest statement

Conflict-of-interest statement: The authors deny any conflict of interest.

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