Purpose:
The lifetime incidence of foot ulcers in patients with diabetes may be as high as 25%. ESRD increases the risk of diabetic foot ulceration and amputation. Taiwan has the highest ranking of incidence and prevalence of dialysis worldwide. Therefore, we collect data of diabetic foot in patients with ESRD under hemodialysis in our hospital to understand the long-term outcomes in those patients with different surgical intervention.
Materials and Methods:
A retrospective single-centre study including patients from January 2005 to June 2017. The data of basic characteristics, local findings, surgical outcomes and survival rate between three groups of different surgical methods are analysed.
Results:
A total of 90 patients were included in our study. 13 patients were in the free flap reconstruction group, 31 patients were in the amputation group, and the rest were in the group of other treatments. The 3-year morality rates were 38.5%(free flap group), 54.8%(amputation group) and 28.3%(other treatments) respectively. The rate of surgical complication was comparable in three groups. There is higher proportion of damaged vessel over lower limbs in free flap group (69.2%; amputation group = 45.5%; other group = 45.7%).
Conclusion:
The proportion of damaged vessel over lower limbs in free flap group was higher and more vascular surgeries, like bypass or percutaneous transluminal angioplasty, should be performed. Compared with the amputated group, the groups of free flap reconstruction and other treatments have a higher 3-year survival rate in hemodialysis patients with diabetic foot ulcer. Therefore, limb salvage in selected patients with ESRD under hemodialysis may be a better option.