Diabetic foot amputations are a medical indicator of shame. Doctors call this drastic procedure the operation of despair. – We have far too many amputations in Poland – emphasizes Mariusz Chabowski, MD, a surgeon.
- Diabetic foot is a serious complication of diabetes. It manifests itself with infection, ulceration and destruction of deep tissues of the foot, including bones
- In the world, removal of a limb or part of a limb – for example a finger – for a diabetic foot occurs every 30 seconds
- Complication significantly increases the risk of premature death: five years after limb amputation, no more than 30% survive. operated people
- More information can be found on the Onet homepage
Edyta Brzozowska, Medonet: Although little is said about it, a complication of diabetes such as diabetic foot syndrome is not rare.
Dr hab. n. med. Mariusz Chabowski, surgeon at the 4th Military Clinical Hospital in Wrocław: It must be remembered that there are about 3 million diabetics in Poland. This is a lot, as much as 8 to 10 percent. society, with some patients unaware of the seriousness of the disease. Statistics show that about 1/3 of these people will develop a very serious complication, which is the diabetic foot.
How can this disease be briefly described?
Generally speaking, a diabetic foot manifests as ulceration. This means tissue necrosis that must be excised or, as a last resort, a limb amputated. Imagine that in the world a limb or part of a limb, for example a finger, is removed every 30 seconds for a diabetic foot! Long-term mortality in amputated patients is also high.
Importantly, diabetes is often accompanied by neuropathy, a complication that causes pain of varying severity. These can be pain in the feet, especially at night, tingling and burning sensations, hyperesthesia, feeling that they are hot or cold, etc. Diabetic patients often do not feel pain, so their vigilance – despite ulceration – is dormant. All this further increases the risk of foot damage and the development of a diabetic foot. Considering that diabetes is most often associated with generalized atherosclerosis, the healing of ulcers and wounds on the lower extremities is additionally hampered by ischemia.
How is a diabetic foot treated?
Treating a diabetic foot is primarily treating diabetes. The diabetologist selects the appropriate therapy and recommends keeping a diary in which the patient writes down information about meals, medications and his physical activity. It all affects the sugar level.
Diabetes mellitus is an interdisciplinary disease. The patient should cooperate with a podiatrist and podiatrist, i.e. a specialist in foot problems and an orthopedist, because a very important issue in a diabetic foot is to relieve the affected limb. Only then can ulcers heal. An angiologist who specializes in the treatment of vascular diseases, i.e. veins and arteries, and a surgeon play a key role in the treatment of diabetic foot. Of course, in the local treatment of the diabetic foot, we use special dressings soaked in appropriate substances that prevent bacterial contamination.
When the diabetic foot is at a very advanced stage, the doctors’ decision can be drastic.
I call the need for an amputation an operation to despair. This is a failure of medicine. We have far too many of them in Poland, which is clearly visible in comparison to other European Union countries. This is due to a malfunctioning specialist outpatient care system. Because in Poland, care for patients with diabetic foot is insufficient. For example, there is only one Chronic Wound Treatment Clinic in Wrocław. This is definitely not enough. Patients do not know where to turn for specialist help. So they go, for example, to a dermatologist whose role in the diabetic foot is small. The dermatologist should recognize the diabetic foot and refer the patient to the appropriate specialist.
Hence my conclusion that education has a huge role to play, and that television – instead of a show about singing or dancing stars – should show people winning against the omnipresent obesity epidemic.
How do patients react to the news about the need for amputation?
It is a great tragedy for them. Apart from the colostomy involving the removal of the large intestine through the abdominal wall and the performance of an artificial anus, limb amputation is the most traumatic.
Patients should be explained then that if the destructive changes have affected the bones, the lower limb can no longer be saved. On the contrary, further attempts at local treatment and limb salvage may result in higher amputation and systemic infection – sepsis. A significant problem is also the willingness of patients to undergo rehabilitation after amputation. Some patients want to undergo rehabilitation, and some do not return to normal functioning. This is where the important role of the psychologist begins.
Why the high mortality rate in patients who have had their diabetic foot amputated?
Five years after an amputation, no more than 30 percent survive. operated people. The reason for this state of affairs is, among others depression, but also quality of life, which deteriorates drastically.
Regular tests are very important for people who have a genetic predisposition or lead an unhealthy lifestyle. We recommend a diagnostic test package Check if you have diabetes available on Medonet Market. It includes the determination of glycated hemoglobin, glucose, the performance of a lipidogram and urinalysis.
Do you perform a lot of such operations?
A lot of. In our surgical clinic, we perform amputation at least several times a week. Diabetic foot amputations are a medical indicator of shame. Let me repeat: it proves the malfunctioning of outpatient specialist care and the lack of education. The result is that drastically neglected patients come to us on the ER, although the diabetic foot is a chronic disease and develops for months. Of course, we never refuse treatment, but this is not how diabetic foot therapy should be.
We encourage you to listen to the latest episode of the RESET podcast. This time, we asked Orina Krajewska what, according to her, a holistic approach to health is. How to combine the three aspects – body, spirit and mind to enjoy balance and good health? You will hear about this and many other aspects of the topic in the latest episode of our podcast.