Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492006000200008
Jornal Vascular Brasileiro
Original Article

Fatores predisponentes para amputação de membro inferior em pacientes diabéticos internados com pés ulcerados no estado de Sergipe

Predisposing factors for amputation of lower extremities in diabetic patients with foot ulceration in the state of Sergipe

Marco Antonio Prado Nunes; Karla Freire Resende; Aldemar Araújo Castro; Guilherme Benjamin Brandão Pitta; Luis Francisco Poli de Figueiredo; Fausto Miranda Jr.

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Resumo

OBJETIVO: Determinar os fatores predisponentes para a amputação de membros inferiores nos doentes internados com diabetes melito e úlceras nos pés. MÉTODOS: Foram acompanhados os pacientes diabéticos com úlceras nos pés internados no período de 6 meses e analisadas as amputações nesses doentes em relação à idade, sexo, amputação prévia, número de ulcerações, tempo de diagnóstico do diabete, tempo de ulceração, tempo médio de internação, gravidade das lesões, presença de pulso. RESULTADOS: Verificou-se que 55% (44/80) dos doentes evoluíram para algum tipo de amputação de membros inferiores; a mediana das idades foi de 61 anos, porém a ocorrência de amputação foi significativamente maior na faixa etária dos 60 aos 90 anos (P = 0,03). Não se observou uma variação significativa da mediana do tempo de diagnóstico do diabetes, do tempo de ulceração e do tempo médio de internação em relação ao grupo de pacientes que foram amputados. Entretanto, as lesões mais graves, quando avaliadas pela classificação de Wagner (P <0,001) e pela ausência de detecção dos dois pulsos distais (P <0,001) dos membros inferiores, revelaram-se bastante significativas com relação ao desfecho de amputação. CONCLUSÃO: Foram considerados fatores predisponentes para a ocorrência de amputação nesses doentes a gravidade das lesões, a ausência de pulsos e as idades acima de 60 anos.

Palavras-chave

Amputação, diabetes melito, pé diabético, úlcera

Abstract

OBJECTIVE: To determine the predisposing factors for amputation of lower limbs in diabetic patients with foot ulceration. METHODS: The research was carried out in hospitals, and all diabetic patients with foot ulceration were included. Amputation was studied in relation to age, sex, previous amputation, number of ulcers, time of diagnosis of diabetes mellitus, time of ulceration, average number of days in hospital, Wagner's classification, and presence of foot pulse. RESULTS: We verified that 55% (44/80) of the patients progressed to some type of amputation of the lower limbs; mean age was 61 years, but the occurrence of amputation was significantly higher in the age group between 60 and 90 years (P = 0.03). We did not observe a significant variation in the following variables: time of diagnosis of diabetes, time of ulceration, and hospitalization time in relation to the group of patients who were amputated. Nevertheless, the most severe lesions, when evaluated by Wagner's classification (P <0.001) and by the absence of both distal pulses (P <0.001) of lower limbs, turned out to be very significant in relation to the amputation outcome. CONCLUSION: The severity of lesions, the absence of pulse and age over 60 years were considered predisposing factors for amputation in these patients.

Keywords

Amputation, diabetes mellitus, diabetic foot, ulcer

References

Spichler ER, Spichler D, Lessa I, Costa e Forti A, Franco LJ, LaPorte RE. Capture-recapture method to estimate lower extremity amputation rates in Rio de Janeiro, Brazil. Rev Panam Salud Publica.. 2001;10:334-40.

Most RS, Sinnock P. The epidemiology of lower extremity amputation in diabetic individuals. Diabetes Care.. 1983;6:87-91.

van Houtum WH, Lavery LA, Harkless LB. The costs of diabetes related lower extremity amputations in the Netherlands. Diabet Med.. 1995;12:777-81.

International Diabetes Federation: Diabetes care and research in Europe: the Saint Vincent declaration. Diabet Med.. 1990;7.

King H. Colaboración regional entre la OMS y la Federación Internacional de la Diabetes: Editoriales. Boletín de la Organización Mundial de la Salud. 2000;2(9).

Consenso internacional sobre o pé diabético. 2001.

Normas para avaliação e tratamento do diabetes mellitus nas unidades básicas de saúde. 2004.

Comparing the incidence of lower extremity amputations across the world: the Global Lower Extremity Amputations Study. Diabet Med.. 1995;12:14-8.

Faglia E, Favales F, Morabito A. New ulceration, new major amputation, and survival rates in diabetic subjects hospitalized for foot ulceration from 1990 to 1993: a 6,5 year follow-up. Diabetes Care. 2001;24:78-83.

Apelqvist J, Larsson J. What is the most effective way to reduce incidence of amputation in the diabetic foot?. Diabetes Metab Res Rev.. 2000;16(^s1):S75-S83.

Epidemiology of lower extremity amputation in centres in Europe, North America and East Asia: The Global Lower Extremity Amputation Study Group. Br J Surg.. 2000;87:328-37.

Ramsey SD, Newton K, Blough D. Incidence, outcomes, and cost of foot ulcers in patients with diabetes. Diabetes Care. 1999;22:382-7.

Apelqvist J, Larsson J, Agardh CD. Long term prognosis for diabetic patients with foot ulcers. J Intern Med.. 1993;233:485-91.

Henriksson F, Agardh CD, Berne C. Direct medical cost for patients with type 2 diabetes in Sweden. J Intern Med.. 2000;248:387-96.

Armstrong DG, Lavery LA, Harkless LB. Validation of a diabetic wound classification system: the contribution of depth, infection and ischemia to risk of amputation. Diabetes Care. 1998;21:855-9.

Holstein P, Ellitsgaard N, Olsen BB, Ellitsgaard V. Decreasing incidence of major amputation in people with diabetes. Diabetologia. 2000;43:844-7.

Ebskov LB, Schroeder TV, Holstein PE. Epidemiology of leg amputation: the influence of vascular surgery. Br J Surg.. 1994;81:1600-3.

Wagner FW Jr. The dysvascular foot: a system for diagnosis and treatment. Foot Ankle. 1981;2:64-122.

Oyibo SO, Jude EB, Tarawneh I. The effects of ulcer size and site, patient's age, sex and type and duration of diabetes on the outcome of diabetic foot ulcers. Diabet Med.. 2001;18:133-8.

Kucan JO, Robson MC. Diabetic foot infection: fate of the contralateral foot. Plast Reconstr Surg.. 1986;77:439-41.

Kumar S, Ashe HA, Parnell LN. The prevalence of foot ulceration and its correlates in type 2 diabetic patients: a population-based study. Diabet Med.. 1994;11:480-4.

Abbott CA, Carrington AL, Ashe H. The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabet Med.. 2002;19:377-84.

Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation: Basis to prevention. Diabetes Care.. 1990;13:513-21.

Larsson J, Apelqvist J, Agardh CD, Stenström A. Decreasing incidence of major amputation in diabetic patients: a consequence of multidisciplinary foot care team approach?. Diabet Med.. 1995;12:770-6.

Van Houtum WH, Lavery LA. Outcomes associated with diabetes-related amputations in The Netherlands and in the state of California, USA. J Intern Med.. 1996;240:227-31.

Trautner C, Haastert B, Spraul M, Giani G, Berger M. Unchanged incidence of a lower-limb amputation in a German city, 1990-1998. Diabetes Care. 2001;24:855-9.

Calle-Pascual AL, Redondo MJ, Ballesteros M. Nontraumatic lower extremity amputations in diabetic and non-diabetic subjects in Madrid, Spain. Diabetes Metab. 1997;23:519-23.

Reiber GE, Pecoraro RE, Koepsell TD. Risk factors for amputation in patients with diabetes mellitus: A case-control study. Ann Intern Med.. 1992;117:97-105.

Macfarlane RM, Jeffcoate WJ. Factors contributing to the presentation of diabetic foot ulcers. Diabet Med.. 1997;14:867-70.

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