Journal List > J Korean Foot Ankle Soc > v.20(2) > 1043416

TOOLS
Gwak, Kim, Kim, Lee, and Lee: Risk Factors of Syme Amputation in Patients with a Diabetic Foot
Original Article

J Korean Ophthalmol Soc 2016;20(2):78-83.

Published online: 19 June 2016

DOI: https://doi.org/10.14193/jkfas.2016.20.2.78

Risk Factors of Syme Amputation in Patients with a Diabetic Foot

Heuichul Gwak, Jeongyo Kim†, a, Youngjun Kim, Jeonghan Lee*, Woonseong Lee

Departments of Orthopaedic Surgery and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

*Departments of Orthopaedic Surgery and Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

†Departments of Orthopaedic Surgery and Department of Orthopaedic Surgery, District Hospital, Korea Army Training Center, Nonsan, Korea

Corresponding Author: Jeongyo Kim Department of Orthopaedic Surgery, District Hospital, Korea Army Training Center, 450-8 Deukandae-ro, Yeonmy-eup, Nonsan 33012, Korea

a Current affiliation: Department of Orthopaedic Surgery, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea Tel: 82-51-890-6129, Fax: 82-51-892-6619, E-mail: bluewhisle@hanmail.net

Received 23 January 201613 April 2016       Accepted 19 April 2016

Copyright © 2016 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

This study examined the factors affecting the treatment of diabetes mellitus foot patients who had undergone a Syme amputation.

Materials and Methods:

This study included 17 patients diagnosed with a diabetes mellitus foot and who had undergone a Syme amputation from January 2010 to January 2014. Some of the risk factors (age, body mass index [BMI], disease duration, smoking, ankle brachial index [ABI], HbA1c, serum albumin, total lymphocyte, C-reactive protein [CRP], and serum creatine) that affect the successful Syme amputation were analyzed.

Results:

The healing rate of a Syme amputation was significantly higher when the lymphocyte count was above 1,500 mm3 (p=0.029). The factors affecting the surgical outcome according to multivariate analysis were HbA1c and the BMI (p=0.014, p=0.013). Regarding reamputation, there was a significant difference with HbA1c, lymphocyte, and BMI (p=0.01, p=0.03, and p=0.01). No significant differences were observed with age, disease duration of diabetes mellitus, smoking, ABI, serum albumin, CRP, and serum creatine.

Conclusion:

The HbA1c level, BMI and total lymphocyte count are risk factors that must be considered for successful Syme amputation in patients with diabetic foot disease.

Keywords: Diabetic foot, Risk factors, Syme amputation

REFERENCES

1.Pinzur MS., Stuck RM., Sage R., Hunt N., Rabinovich Z. Syme ankle disarticulation in patients with diabetes. J Bone Joint Surg Am. 2003. 85:1667–72.
crossref
2.Frykberg RG., Abraham S., Tierney E., Hall J. Syme amputation for limb salvage: early experience with 26 cases. J Foot Ankle Surg. 2007. 46:93–100.
crossref
3.Dickhaut SC., DeLee JC., Page CP. Nutritional status: importance in predicting wound-healing after amputation. J Bone Joint Surg Am9. 1984. 66:71–5.
4.Wagner FW Jr. Management of the diabetic neurotrophic foot part II. A classification and treatment program for diabetic, neuropathic, and dysvascular foot problems. The American Academy of Orthopaedic Surgeons. editor.Instructional course lectures. St. Louis: CV Mosby;1979. p. 143–65.
5.Syme J. Surgical cases and observations. Amputation at the ankle-joint9 1843. Clin Orthop Relat Res. 1990. 256:3–6.
6.Waters RL., Perry J., Antonelli D., Hislop H. Energy cost of walking of amputees: the influence of level of amputation. J Bone Joint Surg Am. 1976. 58:42–6.
7.Aulivola B., Hile CN., Hamdan AD., Sheahan MG., Veraldi JR., Skillman JJ, et al. Major lower extremity amputation: outcome of a modern series. Arch Surg. 2004. 139:395–9.
8.Yu GV., Schinke TL., Meszaros A. Syme’s amputation: a retrospective review of 10 cases. Clin Podiatr Med Surg. 2005. 22:395–427.
crossref
9.Bowker JH. Partial foot and Syme amputations: an overview. Clin Prosthet Orthot. 1987. 12:10–3.
10.Dormandy J., Belcher G., Broos P., Eikelboom B., Laszlo G., Konrad P, et al. Prospective study of 713 below-knee amputations for ischaemia and the effect of a prostacyclin analogue on healing. Hawaii Study Group. Br J Surg. 1994. 81:33–7.
11.Pedersen NW., Pedersen D. Nutrition as a prognostic indicator in amputations. A prospective study of 47 cases. Acta Orthop Scand. 1992. 63:675–8.
12.Christman AL., Selvin E., Margolis DJ., Lazarus GS., Garza LA. Hemoglobin A1c predicts healing rate in diabetic wounds. J Invest Dermatol. 2011. 131:2121–7.
crossref
13.Jung HG., Kim YJ., Shim SH., Paik HD. Lower extremity amputations for the diabetic foot complication. J Korean Foot Ankle Soc. 2006. 10:1–6.
14.Reus WF., Robson MC., Zachary L., Heggers JP. Acute effects of tobacco smoking on blood flow in the cutaneous micro-circu-lation. Br J Plast Surg. 1984. 37:213–5.
crossref
15.Choi SJ., Lee CB., Kim MS., Ha JH., Park HT. Incidence and risk factors of ipsilateral foot and lower limb reamputation in diabetic foot patients. J Korean Foot Ankle Soc. 2011. 15:7–12.
16.Ohsawa S., Inamori Y., Fukuda K., Hirotuji M. Lower limb amputation for diabetic foot. Arch Orthop Trauma Surg. 2001. 121:186–90.
crossref

Figure 1.
(A) A 59-year-old man had type II diabetes, amputated toes and skin necrosis. (B) Syme amputation was performed well and walk freely with prosthesis after healing.
jkfas-20-78f1.tif
Figure 2.
(A) A 62-year-old man had diabetic foot ulcer. (B) Below knee amputation was performed due to difficulty of infection control and laboratory abnormality.
jkfas-20-78f2.tif
Table 1.
Wound Features in Healed Group and Unhealed Group
Patient No. Group Sex Age (yr) Wound site Size* Cause
1 1 Male 54 Forefoot Small Necrosis
2 1 Male 50 Forefoot Small Ulcer, infection, necrosis
3 1 Male 58 Midfoot Middle Necrosis
4 1 Male 68 Midfoot Middle Infection, necrosis
5 1 Male 39 Midfoot Large Infection, necrosis
6 1 Male 57 Forefoot Small Infection, necrosis
7 1 Male 61 Forefoot Small Necrosis
8 1 Male 72 Forefoot Small Necrosis
9 1 Male 70 Midfoot Middle Infection, necrosis
10 1 Female 78 Midfoot Middle Infection, necrosis
11 1 Male 85 Midfoot Middle Infection
12 1 Male 66 Forefoot Small Necrosis
13 1 Female 46 Forefoot Middle Necrosis
14 2 Female 49 Midfoot Middle Infection
15 2 Female 70 Forefoot Middle Ulcer, infection, necrosis
16 2 Male 62 Midfoot Middle Infection, necrosis
17 2 Female 85 Forefoot Middle Infection, necrosis

Group 1: healed group, Group 2: unhealed group. *Small: <5 cm, middle: 5∼10 cm, large: >10 cm.

Table 2.
Rate of Healing by Divided Standard Value
Factor No. of patients Success of treatment (n) Rate of healing (%) p-value*
Age (yr) ≥65 8 6 75.0 0.665
<65 9 7 77.8
HbA1c (%) ≥8.0 12 8 66.7 0.208
<8.0 5 5 100.0
Albumin (g/dL) ≥2.5 13 11 84.6 0.219
<2.5 4 2 50.0
Smoking Yes 9 7 77.8 0.665
No 8 6 75.0
ABI ≥0.9 4 3 75.0 0.700
<0.9 13 10 76.9
BMI (kg/m2) ≥25.0 4 2 50.0 0.219
<25.0 13 11 84.6
Creatine (mg/dL) ≥1.2 9 7 77.7 0.665
<1.2 8 6 75.0
CRP (mg/L) ≥3.2 13 10 76.9 0.700
<3.2 4 3 75.0
Total lymphocyte (mm3) ≥1,500 8 8 100.0 0.029
<1,500 9 5 55.6
Wound site Forefoot 9 7 77.7 0.893
Midfoot 8 6 75.0

ABI: ankle brachial index, BMI: body mass index, CRP: C-reactive protein. *Statistical analysis by chi-square test.

Table 3.
Factors’ Effect to the Operative Outcome
Factor p-value*
Age 0.554
DM duration 0.917
HbA1c 0.014
Albumin 0.280
Smoking 0.663
ABI 0.841
BMI 0.013
Creatine 0.371
CRP 0.733
Total lymphocyte 0.052

DM: diabetes mellitus, ABI: ankle brachial index, BMI: body mass index, CRP: C-reactive protein. *Statistical analysis by multivariate analysis.

Table 4.
Values of Factors in Healed Group and Unhealed Group
Factor Group 1 Group 2 p-value
Age (yr) 61.8 66.5 0.55
DM duration (yr) 15.5 15.0 0.91
HbA1c (%) 8.5 10.7 0.01
Albumin (g/dL) 3.00 2.65 0.27
ABI 0.83 0.89 0.58
BMI (kg/m2) 20.3 27.6 0.01
Creatine (mg/dL) 2.1 1.1 0.14
CRP (mg/L) 9.4 7.2 0.73
Total lymphocyte (mm3) 1,540 1,010 0.03

Group 1: healed group, Group 2: unhealed group. DM: diabetes mellitus, ABI: ankle brachial index, BMI: body mass index, CRP: C-reactive protein.

TOOLS
Similar articles