Necrotizing Soft-Tissue Infections in the Feet of Patients With Diabetes: Outcome of Surgical Treatment and Factors Associated With Limb Loss and Mortality
- 24 August 2009
- journal article
- research article
- Published by SAGE Publications in The International Journal of Lower Extremity Wounds
- Vol. 8 (3), 141-146
- https://doi.org/10.1177/1534734609344106
Abstract
The aim of this study was to analyze the outcomes of treatment of necrotizing soft-tissue infections (NSTIs) in the feet of diabetic patients and to determine factors associated with limb salvage and mortality. A retrospective study of a consecutive series of 145 diabetic patients suffering from NSTIs treated in the Diabetic Foot Unit, La Paloma Hospital was done. NSTIs were classified as necrotizing cellulitis if it involved the subcutaneous tissue and the skin, as necrotizing fasciitis if it involved the deep fascia, and as myonecrosis in those cases where muscular necrosis was present. In the necrotizing cellulitis group (n = 109), 8 (7.3%) major amputations were performed. In the necrotizing fasciitis group (n = 25), 13 (52%) major amputations were undertaken. In the myonecrosis group (n = 11), 6 (54.5%) major amputations were performed. Predictive variables related to limb loss were fasciitis (OR = 20, 95% CI = 3.2-122.1) and myonecrosis (OR = 53.2, 95% CI = 5.1-552.4). Predictive variables of mortality were age >75 years (OR = 10.3, 95% CI = 1.9-53.6) and creatinine values >132.6 µmol/L (OR = 5.8, 95% CI = 1.1-30.2). NSTIs of the foot are an important cause of morbidity and mortality in diabetic patients.When fascia and/or muscle are involved, there are significant risks of major amputation.Keywords
This publication has 18 references indexed in Scilit:
- Surgical Management of Diabetic Foot Infections and OsteomyelitisClinics in Podiatric Medicine and Surgery, 2007
- Necrotizing Soft-Tissue Infection: Diagnosis and ManagementClinical Infectious Diseases, 2007
- Validation of the Infectious Diseases Society of America's Diabetic Foot Infection Classification SystemClinical Infectious Diseases, 2007
- Necrotizing Soft Tissue Infections of the Extremities and BackClinical Orthopaedics & Related Research, 2006
- Necrotizing Fasciitis Caused by Community-Associated Methicillin-ResistantStaphylococcus aureusin Los AngelesNew England Journal of Medicine, 2005
- Predictors of Mortality and Limb Loss in Necrotizing Soft Tissue InfectionsArchives of Surgery, 2005
- Diagnosis and Treatment of Diabetic Foot InfectionsClinical Infectious Diseases, 2004
- Surgical Treatment of the Infected Diabetic FootClinical Infectious Diseases, 2004
- A Retrospective Study of Necrotising FasciitisThe International Journal of Lower Extremity Wounds, 2003
- Probing to Bone in Infected Pedal UlcersJAMA, 1995