Assessment of limb salvage in peripheral arterial disease in diabetic foot ulcer: A prospective study

Introduction: The association of peripheral arterial disease in diabetic foot ulcer is an emerging risk factor for accelerated limb amputations. Presence of ischemia delays the wound healing increasing the likelihood of limb loss. Most amputations can be prevented and limbs salvaged through a multimodal treatment of infection control, wound debridement and revascularization procedures. Materials and methods: This was a prospective study which involved type 2 diabetic patients with isolated foot ulcer (DFU). WIFI- G score was incorporated in the wound assessment. A total of 100 patients were evaluated in this study. Once diagnosed with PAD, patients underwent vascular surgery consultation and were put on appropriate treatment. The patients were followed up for a period of 3 months from definitive procedure to assess the ulcer healing and limb salvage. Results: There was significant association of PAD with high WIFI index. Osteomyelitis was strongly associated with PAD (59%, p=0.003). PAD was associated with higher amputation rates (53.8%, p=0.003). Of minor lower limb amputations, only 47% were associated with PAD whereas of all major amputations, 87% were associated with PAD (p= 0.002). Also higher amputation rates correlated with a high WIFI score (p<0.0001). Conclusion: Revascularization limits the level of amputation and facilitates healing of stump. Major amputations were reduced to half with revascularization. Revascularization if indicated should be done at the earliest onset to attain the benefit of limb salvage.