Surgery helps avoid amputations in diabetics (Reuters)

NEW YORK (Reuters Health) - People with diabetes face a high risk of having to have a foot or lower leg amputated, but timely surgery may prevent this. When bone inflammation -- osteomyelitis -- occurs in the foot and toes, surgery to remove dead areas and to restore circulation can spare more extensive amputations, according to a new report.

"Our series suggests that medical therapy alone is inferior to combined medical and surgical therapy for wound healing and limb salvage," Dr. Peter K. Henke from the University of Michigan School of Medicine, Ann Arbor, and colleagues conclude.

"Aggressive comprehensive care of the diabetic patient with digital osteomyelitis will likely improve outcomes," the team advises in the Annals of Surgery.

In the University of Michigan experience, involving 237 patients with diabetes and non-healing foot or toe ulcers, the affected limb was saved in 80 percent of cases.

Reconstruction of the blood supply improved the chances of wound healing threefold, the researchers note. Also, patients treated surgically rather than with medical therapy required fewer home health services.

Despite their success in avoiding amputations, the investigators stress the need to stop diabetic foot ulcers arising in the first place.

"Like many diseases, preventing the problem is best," Henke told Reuters Health. "Patients with good prophylactic foot care can totally avoid getting an ulcer that precedes development of osteomyelitis. This includes good skin care, good podiatric care, and good diabetic control."

However, if bone inflammation does arise, surgery should be considered early, he advised.

SOURCE: Annals of Surgery, June 2005.

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