Surgical amputation for patients with diabetic foot ulcers: A Chinese expert panel consensus treatment guide

Xuan Liao; Sheng-Hong Li; Mariya Mohamad El Akkawi; Xiao-Bing Fu; Hong-Wei Liu; Yue-Sheng Huang

doi:10.3389/fsurg.2022.1003339

Surgical amputation for patients with diabetic foot ulcers: A Chinese expert panel consensus treatment guide

Front Surg. 2022 Nov 8:9:1003339. doi: 10.3389/fsurg.2022.1003339. eCollection 2022.

Authors

Xuan Liao¹, Sheng-Hong Li¹, Mariya Mohamad El Akkawi¹, Xiao-Bing Fu², Hong-Wei Liu¹, Yue-Sheng Huang³

Affiliations

¹ Department of Plastic Surgery of the First Affiliated Hospital of Jinan University, Institute of New Technology of Plastic Surgery of Jinan University, Key Laboratory of Regenerative Medicine of Ministry of Education, Guangzhou, China.
² Wound Healing and Cell Biology Laboratory, Institute for Basic Research, Trauma Center of Postgraduate Medical College, General Hospital of PLA, Beijing, China.
³ Department of Wound Repair; Institute of Wound Repair and Regeneration Medicine, Southern University of Science and Technology Hospital, Southern University of Science and Technology School of Medicine, Shenzhen, China.

Abstract

Background: Diabetic foot disease is a serious complication of diabetes mellitus. Patients with diabetes mellitus have a 25% lifetime risk for developing a foot ulcer, and between 14% and 24% of patients require a major or minor lower limb amputation due to severe gangrene. However, decisions concerning whether to amputate or whether to perform a major or minor lower limb amputation, and how best to determine the amputation plane remain unclear.

Methods: To consolidate the current literature with expert opinion to make recommendations that will guide surgical amputation for patients with diabetic foot ulcers. A total of 23 experts experienced in surgical treatment of patients with diabetic foot ulcers formed an expert consensus panel, and presented the relevant evidence, discussed clinical experiences, and derived consensus statements on surgical amputation for patients with diabetic foot ulcers. Each statement was discussed and revised until a unanimous consensus was achieved.

Results: A total of 16 recommendations for surgical amputation for patients with diabetic foot ulcers were formulated. The experts believe that determination of the amputation plane should be comprehensively evaluated according to a patient's general health status, the degree of injury, and the severity of lower limb vasculopathy. The Wagner grading system and the severity of diabetic lower extremity artery disease are important criteria when determining the degree of amputation. The severity of both diabetic foot infection and systemic underlying diseases are important factors when considering appropriate treatment. Moreover, consideration should also be given to a patient's socioeconomic status. Given the complexities of treating the diabetic foot, relevant issues in which consensus could not be reached will be discussed and revised in future.

Conclusion: This expert consensus could be used to guide doctors in clinical practice, and help patients with diabetic foot ulcers gain access to appropriate amputation treatment.

Keywords: amputation; diabetic foot management; diabetic foot ulcer; expert consensus; wound healing.