Diabetic foot: presentation and surgical management at Dammam Central Hospital

Diabetic foot sepsis is a common surgical problem in the diabetic population of the Eastern Province of Saudi Arabia. Objectives: The aim of this study is to determine the mode of presentation and outcome of surgical intervention in diabetic foot sepsis. Design: Retrospective review of the case notes of diabetic patients presented with foot sepsis and treated in a surgical ward oy hospital. Setting: Department of Surgery, Dammam Central Hospital, Dammam, Eastern Province, Saudi Arabia. Methods: Collection of demographic data, mode of presentation, investigations, surgical treatment, morbidity and mortality associated with surgery and the final outcome of 68 patients (56 males, 12 females; mean age 65 years) admitted to the surgical ward over a 2 year period from 1 January 1994 to 31 December 1995. Resutls: Majority of patients presented with gangrene. Foot pulses were absent in 20 patients, but angiography was performed in only 10. About 90% of diabetics with foot sepsis required some form of surgical treatments. These included: drainages (twenty), debridements (twenty six), amputations (forty) and vascular reconstruction (six). There were 8 (13%) complications: amputation stump infections (two), flap necrosis (one), skin graft necrosis (one), dehisced stump (one), gangrene tip of big toe (one), vascular graft thrombosis (one) and proximal graft occlusion (one). Two (3.3%) died after surgical intervention as a result of pneumonia and myocardial infarction. The median hospital stay was 35 (range 7-140) days. Conclusion: The most common presentation is gangrene and therefore, amputation is the most common surgical treatment. The great majority of diabetics with foot sepsis will require some form of surgical intervention. The morbidity and mortality associated with surgical intervention including vascular reconstruction is acceptable. Arteriography is an underused investigation in diabetics with absent peripheral pulses. Therefore, arteriography is encouraged in such patients who can be spared the physical and psychological morbidity of a major amputation by a bypass.