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

Ahmed Yousif, Seif Eldin Ibrahim Mahdi, Mohamed ElMakki Ahmed

Abstract


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.

Keywords


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

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References


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