| Abstract [eng] |
Background / objective Diabetes mellitus for a patient is not as dangerous as its complications. One of these complications is diabetic foot syndrome which is the main reason for hospitalization and amputation among patients ill with diabetes mellitus. Although the number of patients ill with diabetic foot syndrome is rapidly increasing, there is no unified system of diabetic foot classification. One of the reasons is that this syndrome must be treated by several clinicians: general surgeons, vascular surgeons, endocrinologists. The topics are analysed from the general surgeon's point of view. The aim of the study was to analyse the epidemiology and symptoms of diabetic foot syndrome, to classify diabetic foot according to three different classification systems used worlwide, and to find the advantages and disadvantages of these classification systems. Methods At the Vilnius City University Hospital, from 1992 to 2002 441 patients with diabetic foot syndrome were hospitalized. The data were collected from queationnaires. Results Of 54.6% of males and 45.4% of females, 85.7% were ill with type II and 14.3% with type I diabetes mellitus. The male to female ratio is 1.2. The average duration of diabetes mellitus for patients hospitalized with diabetic foot syndrome was 13.5 ± 7.9 years, and for 2.9% of patients diabetes mellitus for the first time was diagnosed during hospitalization. The average age was 63.8 ± 11.7 years. 32.9% of patients were hospitalized due to neuropathic, 42.4% due to neuroischemic and 24.7% due to mixed diabetic foot. 29.0% of patients had diabetic nephropathy, 25.8% diabetic retinopathy and 4.5% diabetic encephalopathy. 56.9% of patients had no systemic complications, 29.0% had one, 12.5% had two, 1.6% had three of all the above-mentioned systemic complications. Most frequently there were several diagnoses for a patient. Phlegmon of lower extremity was diagnosed in 88.5%, gangrene in 41.1%, osteomyelitis of foot bones in 29.8% and ulcer of foot in 25.3% of all cases. The average duration of hospitalization was 40.0 ± 1.58 days. The main symptom that affected over 90% of all patients was pain of the lower extremity, over 70% of patients suffered from swelling. Over half of all patients were referred to our hospital because of lower extremity suppuration and foot function disorders. Conclusions Diabetic foot type doesn't depend on the diabetes mellitus type and patient's sex. Diabetes mellitus systemic complications, such as nephropathy, retinopathy, encephalopathy were more common in the mixed type of diabetic foot. Diabetic nephropathy was more common in type I diabetes mellitus. Frequently there were several diagnoses for a patient, e.g., gangrene, phlegmon and ulcer of a lower extremity. Foot ulcers were more common in type II diabetes mellitus. Gangrene of foot is more common in neuroischemic foot. The classification system has to be simple, exact, specific and useful for decision making. The Wagner classification system could be used in out-patient surgery departments, S(AD) SAD classification system could be useful for retrospective studies. Diabetic feet of hospitalized patients could be classified according to the Simple Staging System. |
