Jabir Abu Eliz Diabetic Centre, Khartoum, Sudan.
Department of Surgery, University of Khartoum, Sudan.
J Wound Care. 2022 Nov 2;31(11):941-945. doi: 10.12968/jowc.2022.31.11.941.
Diabetic foot ulceration of toes, forefoot and heel have been extensively studied; however, the dorsum of the foot and the distal leg have rarely been addressed. The objective of this study was to assess diabetic ulcers of the dorsum of the foot and of the distal leg (DUDFDLs) as primary sites, or extended lesions from other foot locations, with regard to possible causes, management and outcomes.
This was a retrospective study conducted in Jabir Abu Eliz Diabetic Centre (JADC) in Khartoum from January 2018 to August 2019. All patients with a primary DUDFDL, or one extending from a plantar or heel ulcer, were included.
A cohort of 102 patients with DUDFDLs were studied; 74 (72.5%) were male and 28 (27.5%) were female, with a male-to-female ratio of 2.6:1, and a mean age of 57±12 years. The ulcer was a primary DUDFDL in 38 patients and a secondary ulcer in 64 patients. The outcome in 38 patients with primary DUDFDL was healing without amputation in 26 cases (68.4%), amputation of toes in 12 cases (31.6%), and no major amputation or death. Of the 64 patients presenting with secondary DUDFDL extending from the plantar surface, there was extension to the dorsum of the foot through the forefoot ulcer in 54 patients and through the ankle joint to the distal leg in 10 patients. For the plantar ulcers extending to the dorsum, five cases healed without amputation (9.3%), minor amputation was necessary in 29 cases (53.7%), major amputation in 14 cases (25.9%) and six patients died (11.1%). For the distal leg ulcers with extension through the ankle joint, five healed without amputation and five required minor amputation.
Primary DUDFDLs had a favourable outcome. Dorsum extension of diabetic foot ulcer from the plantar aspect of the foot carries a high risk for major limb amputation and death.
糖尿病足溃疡的脚趾、前足和足跟已经得到了广泛的研究；然而，足背和小腿远端却很少涉及。本研究的目的是评估足背和小腿远端（DUDFDL）的糖尿病溃疡作为原发性部位，或从其他足部位置延伸的溃疡，探讨其可能的病因、治疗和结局。
这是 2018 年 1 月至 2019 年 8 月在喀土穆的贾比尔·阿布·埃利兹糖尿病中心（JADC）进行的一项回顾性研究。所有患有原发性 DUDFDL 或从足底或足跟溃疡延伸而来的患者均被纳入研究。
研究了 102 例 DUDFDL 患者，其中 74 例（72.5%）为男性，28 例（27.5%）为女性，男女比例为 2.6:1，平均年龄为 57±12 岁。38 例患者的溃疡为原发性 DUDFDL，64 例为继发性溃疡。38 例原发性 DUDFDL 患者的结局为：26 例（68.4%）无截肢愈合，12 例（31.6%）截趾，无重大截肢或死亡。64 例从足底延伸而来的继发性 DUDFDL 患者中，54 例通过前足溃疡向足背延伸，10 例通过踝关节向小腿远端延伸。对于延伸至足背的足底溃疡，5 例无截肢愈合（9.3%），29 例需要小截肢（53.7%），14 例需要大截肢（25.9%），6 例死亡（11.1%）。对于通过踝关节延伸至小腿远端的溃疡，5 例无截肢愈合，5 例需要小截肢。
原发性 DUDFDL 结局良好。糖尿病足溃疡从足底向足背扩展会导致严重的肢体截肢和死亡风险增加。
