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DFSI mumbai 2006

Dr. Johny Kannampilly Consultant Diabetologist & Diabetic foot specialist, Diabetes centre & Diabetes LEAP (Lower Extremity Amputation Prevention) Centre Lakeshore Hospital & Research Centre, Kochi. DFSI mumbai 2006. IS AMPUTATION THE ANSWER TO DIABETIC FOOT PROBLEMS ?. DFSI mumbai

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DFSI mumbai 2006

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  1. Dr. Johny KannampillyConsultant Diabetologist & Diabetic foot specialist,Diabetes centre & Diabetes LEAP (Lower Extremity Amputation Prevention) CentreLakeshore Hospital & Research Centre, Kochi DFSI mumbai 2006

  2. IS AMPUTATION THE ANSWER TO DIABETIC FOOT PROBLEMS ? DFSI mumbai 2006

  3. BURDEN • 1 Amputation in every 10th minute • 45000 India Every Year • 85% Of Amputations Are Due To Untreated And/Or Inadequately Treated Diabetic Foot Ulcers DFSI mumbai 2006

  4. BURDEN OF DIABETIC FOOT • Majority Of Diabetic Foot Ulcers In India Are Neuropathic Infective • 15% Lesions Have Associated Vasculopathy • Prevention Is Easy And Treatment Is Cost Effective DFSI mumbai 2006

  5. WHY FOOT NEEDS TO BE SAVED IN DIABETES ? • Bk Amputation Requires 40% More Kcal/Min • Net Oxygen Consumption Increases • Needs 5 -10 % Extra Cardiac Reserve • 85% Mortality At The End Of 5 Years DFSI mumbai 2006

  6. MORTALITY FOLLOWING AMPUTATION 1 year - 11-41% 3 years - 20-50% 5 years - 39-68% Krauts et al. Foot 1997 Boyko et al. Diabetic Med. 1996 DFSI mumbai 2006

  7. Relation of lower-extremity amputation to all-cause and cardiovascular disease mortality in American Indians: the Strong Heart Study..Diabetes Care. 2004 Jun;27(6):1286-93 OBJECTIVE: compare risk of all-cause and cardiovascular disease (CVD) mortality in people with a lower-extremity amputation (LEA) attributable to diabetes and people without an LEA. RESEARCH DESIGN AND METHODS: study of CVD and its risk factors in 13 American-Indian communities. LEA was ascertained at baseline by direct examination of the legs and feet. Mortality surveillance is complete through 2000. RESULTS: 2,108 participants with diabetes 134 participants (6.4%) had an LEA. Abnormal ankle-brachial index (53%), albuminuria (87%),

  8. Diabetes Duration Diabetic participants without LEA- 11.9 years Toe amputation -18.6years Below-the-knee amputations -21.1 years Diabetic subjects with LEA - 19.8 years During 8.7 (+/-2.9) years of follow-up 102 of the participants with LEA (76%) died from all causes 35 (26%) died from CVD 1,974 diabetic participants without LEA at baseline, 604 (31%) died from all causes and 206 (10%) died from CVD. CONCLUSIONS: LEA is a potent predictor of all-cause and CVD mortality in diabetic American Indians.

  9. SECOND LEG AMPUTATION 6-30 % within 1-3 years 12 % at 1 year 28-51 % at 5 years Diabetic Med. 1992 DFSI mumbai 2006

  10. Risk of contralateral limb • Extra weight –bearing load on contralateral foot increase-risk for ulceration-progress to amputation • Work of walking –energy expeniture increase DFSI mumbai 2006

  11. Deformed Foot With Good Foowear Is Preferable To Amputed Leg With Sophisticated Prosthesis DFSI mumbai 2006

  12. DEFORMED BUT “WALKABLE”DIABETIC FOOT DFSI mumbai 2006

  13. NEWER TECHNOLOGIES

  14. Syme ankle disarticulation in patients with diabetes.J Bone Joint Surg Am. 2003 Sep;85-A(9):1667-72 METHODS: Ninety-seven adult patients with diabetes mellitus who underwent Syme ankle disarticulation because of a neuropathic foot with an infection or gangrene, or both, during an eleven-year period were studied retrospectively RESULTS: Eighty-two patients (84.5%) achieved wound-healing. At a minimum follow-up of two years, all but two patients were able to walk with a prosthesis. Thirty of the ninety-seven patients died at an average of 57.1 months following surgery. CONCLUSIONS:. This function-sparing amputation can be successfully performed with a reasonable risk. Patients managed with a Syme ankle disarticulation appeared to remain able to walk better and to survive longer than similar patients who had a transtibial amputation and served as historical controls.

  15. Mobility outcome following unilateral lower limb amputation.Prosthet Orthot Int. 2003 Dec;27(3):186-90 Study concludes that mobility rates one year after prosthetic provision for unilateral trans-tibial and trans-femoral amputees worsen with increasing age at amputation and a higher level of amputation. DFSI mumbai 2006

  16. DIABETIC FOOT AMPUTATION IN 19TH CENTURY DFSI mumbai 2006

  17. “I Marvel A Society Which Is Ready To Pay A Surgeon A Large Amount Of Money To Amputate A Leg But Nothing To Save It “George Bernad Shaw

  18. CONSCLUSION • Amputation is the easy choice for the treating doctor and also quick remedy for the patient • Conservative foot salvage is time consuming for the doctor and patient. It needs skill and perservence by the doctor and patience by the patients • But conservative foot salvage has better long term outcome in terms of mortality and morbidity • Long term financial cost is the same for both amputated patients and conservative foot salvage patients DFSI mumbai 2006

  19. An ancient Sanskrit saying.“ The one who walks, his good fortune also marches ahead. ” PRESERVE & PROTECT THEM DFSI mumbai 2006

  20. THANK YOU DFSI mumbai 2006

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