Prediction of wound complications after major amputation for patients with critical limb ischemia

Abstract

Background/aim Management of patients with critical limb ischemia from peripheral vascular disease is still a big issue for vascular and endovascular surgeons. For patients who are not candidates for revascularization, 20–40% will undergo major amputation within 6–12 months. Mortality following major amputation of the lower extremity in these patients has been high. This study aims at identifying important factors that lead to wound complications following major amputation in patients with end-stage critical ischemia. Patients and methods This study enrolled 120 in patients who underwent major lower extremity amputations affected by critical limb ischemia, since January 2017 and till March 2020, in the Vascular Surgery Departments at Al-Azhar University Hospitals, Cairo, Egypt. A total of 67 patients underwent transfemoral above-knee amputations (AKA) and 53 underwent transtibial below-knee amputations (BKA). The follow-up was done at first week and first, third, and sixth months postoperatively, and 1-year mortality was assessed as well. The various risk factors were analyzed in this study, including age, coronary artery disease, chronic heart failure, cerebrovascular disease, hypertension, diabetes mellitus, hemodialysis, white blood cell (WBC) count, C-reactive protein-quantitative (CRP), lactate dehydrogenase, and serum albumin level. Results The present study exhibited that most cases were men (75%) and former smokers (64.2%). A total of 91 patients (75.8%) had a history of hypertension. Univariate analysis exhibited that there were defiantly more wound occurrences (P<0.05) for those patients who underwent BKA in the greater than or equal to 55-year-old age group, smokers, patients with high WBCs, patients with low serum albumin level and with positive CRP, and dialysis-dependent patients. However, the patients who underwent an AKA, the multivariate analysis determined positive CRP and dialysis dependent as significant predictors (P<0.05) of a wound occurrence. Conclusion Predictors that significantly increased the risks of delayed recovery for those who underwent BKAs are greater than or equal to 55-year-old group, smokers, patients with elevated WBCs, and patients on dialysis proved to be predictive, and for AKA the predictive factors were low serum albumin level, patients with high WBCs, and patients with dialysis dependence.

Keywords

• critical limb ischemia
• major amputation
• wound healing