Diabetic Foot Clinic, Department of Surgery, General Assembly of Damascus Hospital, Damascus, Syria.
Department of Surgery, Al-Mouwasat University Hospital, Damascus University, Faculty of Medicine, Damascus, Syria.; Department of Surgery, Syrian Private University, Faculty of Medicine, Damascus, Syria.
J Diabetes Complications. 2020 Feb;34(2):107493. doi: 10.1016/j.jdiacomp.2019.107493. Epub 2019 Nov 26.
Diabetic foot patients in Syria faced many challenges and difficulties during the recent long term crisis that has prevailed since 2011. This study establishes the risk factors of diabetic foot amputation, either minor or major amputation. It also suggests facilities to improve diabetic foot care in the disaster.
This is a retrospective study that reviewed diabetic foot outpatients' charts between Jan 2012 and Dec 2017 in Diabetic Foot Clinic in Damascus Teaching Hospital, Syria. We classified the lesions according to the final outcome into: non-amputation, minor and major amputation. We predicted the independent risk factors of lower extremity amputation (LEA).
A total of 2317 diabetic patients visited our clinic regularly with 2722 diabetic foot symptoms. We studied 2006 lesions belong to 1630 diabetic foot patients. They were divided into: group A (outcome without amputation, n = 1372), group B (outcome with minor amputation, n = 528) and group C (final outcome with major amputation, n = 106). Males were slightly predominant (56.73%; n = 1138), but with clearly higher risk of major amputation (6.77%; n = 77). 15.10% of patients was older than 70 years, with no significant relationship between age and amputation risk. According to Meggitt-Wagner classification system, the major amputation rate was (5.28%) in the lesions grade 1 through 5, it went up to (87.30) in isolated grade 5 lesions. The study recorded a degree of infection in (42.07%; n = 844) of the cases. The amputation rate went up in this group of patients to 38.5% and 8.44% for minor and major amputation, respectively. The presence of peripheral occlusive artery disease (PAD) doubled the minor amputation incidence one time (44.02%), and major amputation incidence five times (15.16%). The heel ulcer showed a great tendency toward the major amputation (18.80%), while the incidence rate in the DFUs spared heel was (3.36%). The war injuries of the diabetic foot was followed up in three cases that were treated conservatively and didn't considered an independent risk factor for amputation as long as the standard care was applied.
This article is the first one that discussed the reality of the diabetic foot care in disasters. It figures out that diabetic foot patients are obviously at higher risk of neglect during the crisis. In the absence of early detecting of wounds, deformities and PAD, DFUs likely come to the podiatrists in advanced stages. The unhealthy environment drives DFUs toward injuries, cellulites and infection. Non-Governmental Organizations (NGOs) and local institutions that work in crisis areas should pay attention for special care requirements of diabetic foot patients, for the standard care of the diabetic foot and the regular follow-up till the healing eventually.
自 2011 年以来，叙利亚长期危机期间，糖尿病足患者面临许多挑战和困难。本研究旨在确定糖尿病足截肢（无论是小截肢还是大截肢）的危险因素，并提出改善灾难中糖尿病足护理的设施。
这是一项回顾性研究，对 2012 年 1 月至 2017 年 12 月在叙利亚大马士革教学医院糖尿病足诊所就诊的糖尿病足门诊患者的图表进行了回顾。我们根据最终结果将病变分为：非截肢、小截肢和大截肢。我们预测下肢截肢（LEA）的独立危险因素。
共有 2317 名糖尿病患者定期到我们的诊所就诊，有 2722 名糖尿病足患者出现症状。我们研究了 2006 处病变，涉及 1630 名糖尿病足患者。他们被分为：A 组（无截肢结局，n=1372）、B 组（小截肢结局，n=528）和 C 组（大截肢结局，n=106）。男性略占优势（56.73%；n=1138），但大截肢风险明显更高（6.77%；n=77）。15.10%的患者年龄大于 70 岁，但年龄与截肢风险之间无明显关系。根据梅格特-瓦格纳分类系统，病变 1 至 5 级的大截肢率为（5.28%），孤立 5 级病变的大截肢率上升至（87.30%）。研究记录了 42.07%（n=844）病例的感染程度。在该组患者中，截肢率上升至小截肢和大截肢分别为 38.5%和 8.44%。外周动脉疾病（PAD）的存在使小截肢的发生率增加了一倍（44.02%），使大截肢的发生率增加了五倍（15.16%）。跟骨溃疡有较大的大截肢倾向（18.80%），而 DFU 中未累及跟骨的溃疡发生率为（3.36%）。糖尿病足的战争创伤有 3 例，保守治疗后随访，只要应用标准治疗，就不认为是截肢的独立危险因素。
本文是第一篇讨论灾难中糖尿病足护理现状的文章。它指出，糖尿病足患者在危机期间明显面临更高的忽视风险。在伤口、畸形和 PAD 早期检测缺失的情况下，DFUs 可能会进入足病医生的治疗范围。恶劣的环境使 DFUs 容易受到伤害、蜂窝织炎和感染。在危机地区工作的非政府组织（NGO）和当地机构应注意糖尿病足患者的特殊护理需求，对糖尿病足进行标准护理，并定期随访，直至最终愈合。
