Primadhi RA, Septrina R, Hapsari P, Kusumawati M. Amputation in diabetic foot ulcer: A treatment dilemma. World J Orthop 2023; 14(5): 312-318 [PMID: 37304194 DOI: 10.5312/wjo.v14.i5.312]
Corresponding Author of This Article
Raden Andri Primadhi, MD, PhD, Assistant Professor, Surgeon, Department of Orthopaedics and Traumatology, Universitas Padjadjaran/Hasan Sadikin Hospital, Jalan Pasteur 38, Bandung 40161, Indonesia. randri@unpad.ac.id
Research Domain of This Article
Orthopedics
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. May 18, 2023; 14(5): 312-318 Published online May 18, 2023. doi: 10.5312/wjo.v14.i5.312
Amputation in diabetic foot ulcer: A treatment dilemma
Raden Andri Primadhi, Rani Septrina, Putie Hapsari, Maya Kusumawati
Raden Andri Primadhi, Department of Orthopaedics and Traumatology, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung 40161, Indonesia
Rani Septrina, Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung 40161, Indonesia
Putie Hapsari, Division of Vascular and Endovascular Surgery, Department of Surgery, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung 40161, Indonesia
Maya Kusumawati, Internal Medicine, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung 40161, Indonesia
Author contributions: Primadhi RA performed the majority of the writing and figure preparation; Septrina R, Hapsari P, and Kusumawati M provided input and correction into the paper writing.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Raden Andri Primadhi, MD, PhD, Assistant Professor, Surgeon, Department of Orthopaedics and Traumatology, Universitas Padjadjaran/Hasan Sadikin Hospital, Jalan Pasteur 38, Bandung 40161, Indonesia. randri@unpad.ac.id
Received: March 2, 2023 Peer-review started: March 2, 2023 First decision: March 24, 2023 Revised: March 27, 2023 Accepted: April 18, 2023 Article in press: April 18, 2023 Published online: May 18, 2023 Processing time: 77 Days and 9.1 Hours
Abstract
Diabetic foot is a clinical manifestation of diabetes with a wide range of symptoms, including ulceration, osteomyelitis, osteoarticular destruction, and gangrene, as a consequence of advanced disease. Some diabetic foot cases present general indications for amputation, including dead limb, threat to the patient’s life, pain, loss of function, or nuisance. Various tools have been introduced to help decision-making in amputation for diabetic foot. However, it remains a conundrum because diabetic foot involves multiple pathomechanisms and factors that hinder its outcomes. Sociocultural issues often impede treatment from the patient’s side. We reviewed different perspectives in diabetic foot management, particularly related to amputation. In addition to deciding whether to amputate, physicians should address amputation level, timing, and ways to avoid patient deconditioning. Surgeons should not be autocratic in these circumstances and should be aware of beneficence and maleficence when considering whether to amputate. The main goal should be improving the patients’ quality of life rather than preserving the limb as much as possible.
Core Tip: Making a decision regarding amputation for diabetic foot patients is not as simple as following guidelines, such as scoring systems. There are many influential factors that come from different perspectives and are sometimes contradictory. Decision-making should consider other clinical and sociocultural factors, with the improvement of patient quality of life as the main goal.
