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Simple blood test helps diabetic patients avoid leg amputation
<< BACK | Download Word File Vancouver, August 23, 2004 — A simple blood test can now predict the probability of success for a surgical procedure that can save the lower leg of diabetic patients facing amputation, according to a study by a group of researchers at St. Paul's Hospital in Vancouver. The study, conducted by Dr. Alastair Younger, Dr. Timothy Kalla and several Orthopaedic Fellows at Providence's Foot and Ankle Clinic, examined 21 patients with diabetes who received successful partial foot amputations and 21 diabetic patients who experienced a failed amputation. Results showed that those patients with better blood glucose control had a high rate of success with a forefoot amputation and did not need a below-knee amputation. When a diabetic patient develops a foot ulcer (a persistent open sore on the bottom of the foot) that does not heal with treatment, it becomes larger and badly infected. In most circumstances, Orthopaedic surgeons will quickly perform a below knee amputation (BKA) to stop the infection from spreading, resulting in a patient's loss of mobility and independence and requiring costly long-term hospital care. An alternative surgery to a BKA is a transmetatarsal amputation (TMA), in which only the front portion of the foot containing the infected ulcer is removed. When successful, this limb-saving procedure results in significant personal and financial savings for the patient and hospital system alike, as the patient maintains their mobility and does not require long-term care. The 30 per cent failure rate of TMAs has caused many surgeons to skip an attempt at a TMA and simply perform a more costly BKA. However, foot amputation success can now be partially predicted. According to Dr. Younger, "the most important aspect in the success of a TMA surgery is the quality of diabetic control." Doctors can measure diabetic control with a test that measures a diabetic's glucose level in the blood over the past three months. This gives doctors an indication of how well a diabetic patient is taking care of their diabetes. The lower the percentage of glucose in the blood, the higher the rate of success of a TMA. "When glucose is greater than ten per cent of the blood, the TMA is bound to fail, but when it is below seven per cent the rate of success is high, and a surgeon should perform a TMA," said Dr. Younger. Another improvement on the TMA operation involves a new invention, called Osteoset Beads developed by Write Medical Technologies. These small beads are inserted into the surgical wound after partial amputation to release antibiotics, helping to prevent infection and speed recovery of a patient. Foot ulcerations affect about 15-20 per cent of people with diabetes at some time in their life and related foot disorders are the leading causes of hospitalization for diabetic patients. This study was presented in Seattle at the American Orthopaedic Foot and Ankle Society annual meeting on July 29 and will be presented in Sydney, Australia at the 11th Meeting of the Combined Orthopaedic Associations (Australia, Britain, Canada, New Zealand, South Africa, United States) on October 28, 2004. St. Paul's Hospital is one of six health care facilities operated by Providence Health Care, Canada's largest faith-based health care organization. -30- Contact: Gavin Wilson Communications Providence Health Care 604-806-8583 << BACK | Download Word File |
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