MANAGEMENT OF FOOT LESIONS IN 310 DIABETICS

Objective: To study epidemiology of foot complications in diabetics wi th a view adding to the local data and comparing our experience with o ther local and international experiences. Methods: Medical records of 325 diabetic patients admitted to Riyadh Medical Complex, Riyadh, Saud i Arabia, with foot lesions between September 1986 to August 1991 were studied retrospectively. Data of 310 patients, who completed the trea tment were collected for gender, age, duration of diabetes mellitus, n ature of foot lesions, presence of peripheral vascular disease, periph eral neuropathy, predisposing factors, concurrent medical illness, mic robial flora, types and numbers of surgical procedures, duration of ho spital stay, morbidity and mortality. Results: The majority of patient s were males (69%), Saudis (70%), over fifty years of age (84%), and k nown diabetics (92%). History of trauma preceding foot complications w as present in 23% of patients. Peripheral neuropathy was the main pred isposing factor(58%). Toe gangrene (29%) and foot abscess (24%) were t he most common form of presentation. Wound swabs were positive for bac terial culture in 94% of patients, 59.4% of them were polymicrobial. L ower limb amputations at different levels were the most common (51%) s urgical procedures, 25% of them were major amputations. There were 14 deaths (4.5%) in the study group, mainly due to uncontrolled sepsis wi th concurrent medical illnesses. Conclusions: We conclude that foot co mplications is a common problem in elderly Saudi diabetics, particular ly males. Peripheral neuropathy is the most common predisposing factor . Foot infections are usually polymicrobial. Majority will need some f orm of amputation, a quarter of them, will end up having major limb am putations.