DIABETIC FOOT - PRESENTATION AND SURGICAL-MANAGEMENT AT DAMMAN-CENTRAL-HOSPITAL

Diabetic foot sepsis is a common surgical problem in the diabetic popu lation of the Eastern Province of Saudi Arabia. Objectives: The aim of this study is to determine the mode of presentation and outcome of su rgical intervention in diabetic foot sepsis. Design: Retrospective rev iew of the case notes of diabetic patients presented with foot sepsis and treated in a surgical ward oy hospital. Setting: Department of Sur gery, Dammam Central Hospital, Dammam, Eastern Province, Saudi Arabia. Methods: Collection of demographic data, mode of presentation, invest igations, surgical treatment, morbidity and mortality associated with surgery and the final outcome of 68 patients (56 males, 12 females; me an age 65 years) admitted to the surgical ward over a 2 year period fr om 1 January 1994 to 31 December 1995. Resutls: Majority of patients p resented with gangrene. Foot pulses were absent in 20 patients, but an giography was performed in only 10. About 90% of diabetics with foot s epsis required some form of surgical treatments. These included: drain ages (twenty), debridements (twenty six), amputations (forty) and vasc ular reconstruction (six). There were 8 (13%) complications : amputati on stump infections (two), flap necrosis (one), skin graft necrosis (o ne), dehisced stump (one), gangrene tip of big toe (one), vascular gra ft thrombosis (one) and proximal graft occlusion (one). Two (3.3%) die d after surgical intervention as a result of pneumonia and myocardial infarction. The median hospital stay was 35 (range 7-140) days, Conclu sion: The most common presentation is gangrene and therefore, amputati on is the most The great majority of diabetics with foot sepsis will r equire some form of surgical intervention. The morbidity and mortality associated with surgical intervention including vascular reconstructi on is acceptable. Arteriography is an underused investigation in diabe tics with absent peripheral pulses. Therefore, arteriography is encour aged in such patients who can be spared the physical and psychological morbidity of a major amputation by a bypass.