Indications and short-term outcome of major lower extremity amputations in Khartoum Teaching Hospital

Ahmed Yousif, Seif Eldin Ibrahim Mahdi, Mohamed ElMakki Ahmed


Introduction: Major lower extremity amputation (MLEA) is a common emergency operation in
Khartoum Teaching Hospital (KTH). Diabetic septic foot is the main indication for amputation, which is
always performed by the resident surgical registrar. Post amputation stump infection is the most depressing
complication for a patient who had been suffering from a foot sepsis for a long duration. The objective of
this study was to report the indications and short-term outcome of major lower limb amputation, specifically
post amputation stump infection.
Methods: This was a prospective cross sectional hospital based study done on patients who underwent
MLEA in KTH during the period from March to December 2014. Most patients were later followed up in
Jabir Abu Eliz Diabetic Center (JADC).
Results: Hundred patients were included. The age range was between 11-90 years with a mean age of
57.39±17.93(SD). The majority of patients were in their 4th and 5th decades of life (69%). The M:F ratio
was 2.3:1.0.Seventy seven patients were diabetic, 17 patients were hypertensive, 28 patients with renal
impairment and 29 patients were smokers.
The commonest cause of amputation was diabetes related complications in 77 patients(77%), of whom 58
patients had neuropathic foot and 19 patients had neuroischemic foot. Peripheral vascular disease without
diabetes was the second cause of amputation, occurring in 15 patients (15%).
Stump infection was reported in 43 patients (43%), of whom 23 patients had amputation through a
potentially infected site. Thirty patients of those who developed infection of the stump ended with complete
healing, 21 patients healed after frequent debridement and secondary suture, while nine required proximal
re-amputation. The remaining 13 patients of those who developed infected stump died (10 patients because
of septicaemia and septic shock and 3 from myocardial infarction).
The period of healing ranged from three to 12weeks. Stump infection was significantly associated with
prolonged time of healing. The time of healing in patients without stump infection ranged from three to 6
weeks (n=49) versus 6 to 12 week in those with infected stump (n=30) (P=0.00).
Complete healing was achieved in 79 patients (79%), (49 patients had primary healing, and 30 patients had
secondary healing following stump infection). The perioperative mortality rate was 21% (n=21).
Conclusion: The commonest cause of MLEA was diabetic sepsis, followed by peripheral vascular disease.
Major lower extremity amputation was associated with a considerable rate of morbidity and mortality.
Extra perioperative care is needed to reduce the rate of post amputation stump sepsis.


Indications; short-term; outcome;major lower ;extremity ;amputations; Teaching

Full Text:



Norgren L1, Hiatt WR, Dormandy JA, Nehler

MR, Harris KA, Fowkes FG; TASC II Working

Group. Inter-Society Consensus for the

Management of Peripheral Arterial Disease

(TASC II). Journal of Vascular Surgery 2007;45

Suppl S:S5-67.

Ziegler-Graham K, MacKenzie EJ, Ephraim

PL, Travison TG, Brookmeyer R. Estimating

the prevalence of limb loss in the United States:

to 2050. Archives of Physical Medicine

and Rehabilitation 2008;89:422-9.

Van der Meij, Willem K.N. No leg to stand

on: historical relation between amputation

surgery and prostheseology.Netherlands: Proost

International Book Production, University of

Groningen; 1995. 256

Paudel B, Shrestha BK, Banskota AK. Two

faces of major lower limb amputations.

Kathmandu University Medical Journal

(KUMJ) 2005;3:212-6.

Holstein P, Ellitsgaard N, Sorensen S,et al.

Reduced frequency of amputation in diabetic

patients. Nordisk Medicin 1996;111:142-4.

Ahmed, ME. Diabetic septic foot lesions in

Khartoum. East African Medical Journal


Department of Statistics and Hospital Records.

Khartoum Teaching Hospital. Khartoum,


Larsson J, Eneroth M, Apelqvist J, Stenstrom

A. Sustained reduction in major amputations

in diabetic patients: 628 amputations in 461

patients in a defined population over a 20-year

period. Acta orthopaedica 2008;79:665-73.

Krishnan S, Nash F, Baker N, Fowler D, Rayman

G. Reduction in diabetic amputations over 11

years in a defined U.K. population: benefits of

multidisciplinary team work and continuous

prospective audit. Diabetes Care 2008;31:99-

Suliman MO, H Salim OEF, Ahmed ME. Major

lower limb amputation in diabetics. Khartoum

Medical Journal. 2013;5.122-6

Mohamed IA, Ahmed AR, Ahmed ME.

Amputation and prostheses in Khartoum.

Journal of the Royal College of Surgeons of

Edinburgh 1997;42:248-51.

Zidane B, Salim ME, Seif EIdin Ibrahim

Mahadi Z. Revision Surgery of Major

Limb Amputations, Indications, Surgical

Management and Outcome. Global Journal of

Medical Research 2014;14.3-7

Chalya PL, Mabula JB, Dass RM, et al.

Major limb Amputations: a tertiary hospital

experience in Northwestern Tanzania. Journal

of Orthopaedic Surgery and Research


Jawaid M, Ali I, Kaimkhani GM. Current

indications for major lower limb amputations

at Civil Hospital, Karachi. Pak J Surg


Indications and short-term outcome of major lower extremity amputations in Khartoum Teaching Hospital

Sie Essoh JB, Kodo M, Dje Bi Dje V, Lambin

Y. Limb amputations in adults in an Ivorian

teaching hospital. Nigerian Journal of Clinical

practice 2009;12:245-7.

Doumi E, Ali AJ. Major limb amputations in El

Obeid Hospital, Western Sudan. Sudan Journal

of Medical Sciences 2008;2:237-40.

Rommers GM, Vos LD, Groothoff JW,

Schuiling CH, Eisma WH. Epidemiology

of lower limb amputees in the north of The

Netherlands: aetiology, discharge destination

and prosthetic use. Prosthetics and Orthotics

International 1997;21:92-9.

Kidmas AT, Nwadiaro CH, Igun GO. Lower

limb amputation in Jos, Nigeria. East African

Medical Journal 2004;81:427-9.

Awori KO, Atinga JE. Lower limb amputations

at the Kenyatta National Hospital, Nairobi.

East African Medical Journal 2007;84:121-6.

22.Goodney PP, Holman K, Henke PK, et al.

Regional intensity of vascular care and lower

extremity amputation rates. Journal of Vascular

Surgery 2013;57:1471-79.

Berridge DC, Slack RC, Hopkinson BR, Makin

GS. A bacteriological survey of amputation

wound sepsis. The Journal of Hospital Infection


Toursarkissian B, Shireman PK, Harrison A,

D’Ayala M, Schoolfield J, Sykes MT. Major

lower-extremity amputation: contemporary

experience in a single Veterans Affairs

institution. The American Surgeon 2002;68:606-

Omoke NI, Nwigwe CG. An analysis of risk

factors associated with traumatic extremity

amputation stump wound infection in a

Nigerian setting. International Orthopaedics


Kanade R, van Deursen R, Burton J, Davies V,

Harding K, Price P. Re-amputation occurrence

in the diabetic population in South Wales, UK.

International Wound Journal 2007;4:344-52.

Lepantalo M, Isoniemi H, Kyllonen L. Can

the failure of a below-knee amputation be

predicted? Predictability of below-knee

amputation healing. Annales chirurgiae et

gynaecologiae. 1987;76:119-23.

Low CK, Chew WY, Howe TS, Tan SK. Factors

affecting healing of below knee amputation.

Singapore Medical Journal 1996;37:392-3.


  • There are currently no refbacks.

ISSN: 1858-5345