Predictors and Risk Factors of Wound Complications in Diabetic Patients Post Lower Limb Amputation; A Prospective Study

Introduction: Despite advances in limb-salvage surgery, lower extremity amputation is still commonly required
as an end result of the progression of arterial occlusive disease or failed arterial reconstruction. Furthermore, the
increasing prevalence of diabetes has led to the appearance of more patients with foot complications leading to
eventual lower extremity amputation.
Aim of work: To investigate the predictors and risk factors associated with wound complications after lower limb
amputations in diabetic patients.
Patients and methods: This is a prospective study, in which we follow up diabetic patients who went for lower
limb amputation (AKA or BKA) and record the incidence of post operative wound complications. The study included
30 diabetic patients undergoing lower limb amputation in Ain Shams University hospitals, with postoperative
follow up for 24 weeks, and the outcome measured is the incidence of post operative complication in relation to
preoperative risk factors and predictors.
Results: Regarding the comparison between AKA and BKA it was found that patients who had BKA had higher
rates of superficial SSI which were statistically significant (P<0.05). While patients who had AKA had higher
rates of pneumonia andmortality but not statistically significant (P>0.05). Wound disruption, pulmonary embolism
and MI were higher in patients who had BKA but was not statistically significant (P>0.05). Regarding assessing
predictors and risk factors for assessing post operative complications it was found that female gender, smoking and
obesity (BMI >30) was statistically significant in assessing the risk factors (P value <0.05). Also regarding other
predictors and risk factors of postoperative complication after the end of the study duration it was found that HGb
(Anemia), Hct, ESR and CRP are considered predicators (P-value < 0.05). Other factors such as preoperative sepsis,
emergency status and presence of infection were strongly related to post operative complication P-value 0.003
each (P-value < 0.05).
Conclusion: Surgical site infections (SSIs) following lower extremity amputations (LEAs) are a major cause of
patient morbidity and mortality. The objectives of this study were to investigate the incidence of SSI and risk factors
associated with SSI after LEA in diabetic patients. This study found that below-the-knee amputation, smoking,
obesity, emergency status, anemia, lower hematocrit and preoperative sepsis to be associated with SSIs. Obesity
specifically exacerbates the risk of developing postoperative surgical site infections in patients undergoing abovethe-
knee but not below-the knee amputation surgery.