Avaliação da taxa de amputações. Consulta multidisciplinar do pé diabético.

Abstract

In 1987, it was created the first portuguese Diabetic Foot Clinic in Oporto, at the Hospital Geral de Santo António. The distinction between neuropathic and ischaemic foot was the key stone to reduce drastically the rate of major amputations in the first two years of activity. Since then and until 1995 the rate of major amputations had stabilised around 8%. The aim of the present study was to evaluate if there was any change in the last three years. A retrospective study was performed reviewing the clinical files of 843 new patients between 1998 and 2000. The 593 patients who presented with a foot ulcer with or without infection were selected: 60.4% with neuropathic foot and 39.6% with ischaemic one. Overall, 31 of the 593 patients with ulcer or infection were treated with major amputation (5.2%). There was a statistical difference between the major amputation outcome among the two types of foot (p < 0.001). Necrosis showed to carry a poor prognosis (30.7% in ischaemic foot vs 8,3% in neuropathic, p = 0.024). There was no further statistical significance for age, sex, type or duration of diabetes as risk factors for major amputation. This retrospective study has showed a slight reduction in the rate of major amputations since 1995. Poor prognosis was related to necrosis and ischaemic foot. Further improvement requires harder investment in patients' education, as well as in alerting the primary health care physicians, for the most unpredictable catastrophic complication of diabetes.