— a fear greater than death
The greatest fear for patients with diabetes is the loss of their feet. Many studies show that amputation is an even greater fear than death1 Wukich DK, Raspovic KM, Suder NC. Patients With Diabetic Foot Disease Fear Major Lower-Extremity Amputation More Than Death. Foot Ankle Spec. 2018 Feb;11(1):17-21. doi: 10.1177/1938640017694722. Epub 2017 Feb 1. PMID: 28817962. . From the patient perspective, it is therefore important to save as much of the limb as possible to improve quality of life. At the same time, it is important to avoid costly and difficult reamputations. The clinical decision to amputate should always be supported by different clinical assessments. According to current guidelines and other literature, transcutaneous oxygen (tcpO2 or TCOM) can provide supplementary information in the decision of appropriate amputation levels. (Conte et al. 2019, Benitez et al. 2014).
- Amputation of a lower limb is the greatest fear among patients with diabetes.
- By preserving as much as possible, below the knee or even trans metatarsal, the patient’s likelihood of walking increases.
- Reamputations should be avoided due to the increase in cost and risk for the patient.
- Failure to heal after an amputation is often due to insufficient perfusion.
- tcpO2 can show an objective map over the perfusion of the lower limb to help in determining the ideal level of amputation.
- Wukich DK, Raspovic KM, Suder NC. Patients With Diabetic Foot Disease Fear Major Lower-Extremity Amputation More Than Death. Foot Ankle Spec. 2018 Feb;11(1):17-21. doi: 10.1177/1938640017694722. Epub 2017 Feb 1. PMID: 28817962.
- Conte MS, Bradbury AW, Kolh P et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg. 2019 Jun;69(6S):3S-125S.e40.
- Benitez E, Sumpio BJ, Chin J, Sumpio BE. Contemporary assessment of foot perfusion in patients with critical limb ischemia. Semin Vasc Surg. 2014 Mar;27(1):3-15.
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