Lower extremity amputations in diabetic patients. A 5-year study in the Tainan area

Cases of lower extremity amputations in patients who were admitted to these two institutions from January 1988 to December 1992 were studied. Among the 348 cases with 426 amputations, diabetic cases (40.5%) were the main cause of lower extremity amputations in all patients, and in term 64% in nontraumatic cases. There was no sexual difference in the diabetic cases (M:F = 1.04:1). The age of first amputation ranged from 26 to 86 years old. The percentage of reamputation of the same limb and amputation of the contralateral limb were 22.0% and 11.4%, respectively. Bacteriologic study in diabetic amputees revealed 65.9% mixed infection with an average 2.34 isolates per culture. Among the aerobic gram-positive cocci, Streptococci, Enterococci and Staphyloccus aureus were commonly encountered; Pseudomonas aeruginosa and Klebsiella pneumonia predominated as gram-negative aerobes; and Bacteroid species accounted for the majority of anaerobic isolates. In conclusion, diabetic feet remain the most common cause of lower extremity amputation in the Taiwan area. Infection, high in this group of amputees, showed polymicrobic. A risk for a second similar procedure on either the same or the contralateral limb was increased with prolongation of the diabetic condition. Because lower limb amputation is risky and its morbidity and mortality is high in the diabetic group, much effort should be made to minimize foot damage in diabetic patients.