Characteristics and management of patients undergoing emergency surgery for diabetic foot attack

BACKGROUND: Diabetic foot attack (DFA) is considered one of the worst manifestations of diabetic foot. It is necessary to act quickly to prevent amputation and save the patient’s life. The aim of this study is to reveal the characteristic features of DFAs and be a guide to healthcare professionals to manage and refer these patients.
METHODS: Sixty-five patients with DFAs were analyzed retrospectively. Demographics were collected. All patients’ ýnfectious dis-eases Society of America/International Working Group on the Diabetic Foot (IDSA/IWDGF) stages, site ýschemia neuropathy, bacterial ýnfection and depth (SINBAD) and laboratory risk ýndicator for necrotizing fasciitis (LRINEC) scores were calculated. According to these measurements, patients were categorized and statistical results were obtained.
RESULTS: We found that patients who underwent emergency surgery due to DFA applied to an average of two hospitals before applying to our facility and the median acceptance time since the beginning of the first complaint was 9 days. All patients were IDSA/IWDGF stages three and four. Most of the patients had SINBAD scores between four and six. 60% of the patients were at high risk for necrotizing fasciitis according to the LRINEC score. 58.2% of patients had periferic arterial stenosis and the amputation rate was 69.2%. 21.3% of the patients were followed in the intensive care unit, and our patients’ mortality rate was 4.2%.
CONCLUSION: DFA is an emergency surgical condition that requires high clinical suspicion. If not diagnosed and treated with emergency surgery, it has a high mortality and amputation rate. High white blood cell count in patients, local and systemic signs of inflammation, presence of subcutaneous emphysema in the lower extremities on a direct X-ray radiography, and high blood sugar should be considered as warning signs for DFA. Emergency surgical intervention should be performed on these patients, and if the patient is not in a suitable center for emergency surgery, they should be rapidly referred to a center with experienced clinicians.

Diyabetik ayak krizi nedeni ile acil cerrahi yapýlan hastalarýn özellikleri ve yönetimi

AMAÇ: Diyabetik ayak krizi, diyabetik ayaðýn en kötü klinik tablolarýndan biri olarak kabul edilir. Diyabetik ayak krizinde amputasyonu önlemek ve hastanýn yaþamýný kurtarmak için hýzla hareket etmek gerekir. Bu çalýþmanýn amacý, diyabetik ayak krizinin karakteristik özelliklerini ortaya çýkarmak ve saðlýk profesyonellerine bu hastalarý yönetme ve gerektiðinde sevk etme konusunda rehberlik etmektir.
GEREÇ VE YÖNTEM: Diyabetik ayak krizi nedeni ile deðerlendirilen 65 hasta retrospektif olarak incelendi. Demografik veriler toplandý. Hastalarýn Infectious Diseases Society of America/ International Working Group on the Diabetic Foot (IDSAIWDGF) evreleri, Site Ischemia Neuropathy Bacterial Infection and Depth (SINBAD) ve Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) skorlarý hesaplandý. Bu ölçümlere göre hastalar kategorilere ayrýldý ve istatistiksel sonuçlar elde edildi.
BULGULAR: Çalýþmada, acil cerrahi müdahale gerektiren hastalarýn, merkezimize gelmeden önce ortalama 2 hastaneye baþvurduðu ve ilk þikayet baþladýðýndan beri geçen medyan kabul süresinin 9 gün olduðu bulundu. Tüm hastalarýn IDSA/IWDGF evreleri 3 ve 4'tü. SINBAD skoru 4 ile 6 arasýndaydý. Hesaplanan LRINEC skorlarýna göre hastalarýn %60'ý nekrotizan fasiit açýsýndan yüksek risk altýndaydý. Periferik arteriyel týkanýklýk gö-rülme oraný %58.2 iken hastalarýn %69.2'sine amputasyon yapýldý. Hastalarýn %21.3'ü yoðun bakým ünitesinde takip edildi.Mortalite oraný %4.2 idi. SONUÇ: Diyabetik ayak krizi, yüksek klinik þüphe gerektiren bir acil cerrahi durumdur. Taný konulup acil cerrahi tedavi yapýlmazsa yüksek mortalite ve amputasyon oranýna sahiptir. Hastalarýn yüksek beyaz küre sayýsý, lokal ve sistemik enflamasyon bulgularý, direkt grafide, alt ekstremitelerde cilt altýnda amfizem olmasý ve kan þekeri yüksekliði diyabetik ayak krizi için uyarýcý olmalýdýr. Bu hastalara hýzla acil cerrahi müdahale yapýlmalý, hasta cerrahi için uygun bir merkezde deðil ise deneyimli klinisyenlere sahip bir merkeze hýzla sevk edilmelidir.