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Foot ulceration in persons with diabetes is the most frequent precursor to amputation, which impairs their activities. The aim of this chapter is to describe factors that lead to amputation of a diabetic foot, and propose a management strategy to prevent major amputation. I analyzed 233 patients who were admitted at the National Nagasaki Medical Center between 2008 and 2017 with foot ulcer and/ or infection. We divided them into two groups: 152 patients with diabetes mellitus (DM) and 81 without DM. We analyzed their laboratory data, and evaluated the wound severity, complications of peripheral artery disease (PAD) and renal failure, and infection. Patients with DM ulcer were significantly more likely to receive amputation. Patients with DM were significantly more likely to develop infection, and tended to undergo emergency debridement. Among the patients with DM, the amputation group (85) showed significantly higher levels of CRP and WBC, and was more likely to develop infection, PAD, and renal failure. My results suggest that risk factors leading to leg amputation are severe infection and reduction of arterial blood flow. Early debridement to reduce infectious inflammation and angioplasty following free flap transfer are recommended to preserve legs.

A Retrospective Analysis of Amputation Risk Due to Diabetic Foot and Angioplasty and Free Flap Transfer to Reduce Major Amputation