Published online Sep 15, 2020. doi: 10.4239/wjd.v11.i9.391
Peer-review started: May 7, 2020
First decision: May 24, 2020
Revised: June 6, 2020
Accepted: August 15, 2020
Article in press: August 15, 2020
Published online: September 15, 2020
Processing time: 127 Days and 5.3 Hours
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.
To highlight the long-term outcomes of LEA as a result of DFU.
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.
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.
Previous LEA, level of the LEA and patient comorbidities were significant risk factors contributing to re-ulceration, re-amputation, mortality and depreciated functional status.
Core Tip: There was a significantly higher degree of re-amputation and mortality in those who undergo amputations due to diabetic foot ulcers in addition to impact on quality of life. Data on long-term outcomes in these patients were limited and requires further research to better understand the long-term outcomes in this subset of patients.