Surgical management of patients with diabetic foot ulcers at MOI Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: The Diabetic Foot Ulcer (DFU) is a break in epidermis below ankle in person with Diabetes Mellitus (DM). The prevalence of this disorder is increasing and there is a 15% chance in lifetime of a diabetes mellitus patient developing it. The worldwide prevalence of DFUs has been estimated to be between 4% - 17%. In Kenya, diabetes has a prevalence of 3.3 % - 10%. It is a public health problem particularly in developing countries. DFU is due to neuropathy and poor blood circulation, which can progress to complications such as gangrene and infection, which are attributed to late presentation, poor awareness both among healthcare workers and patients, as well as late referral once they occur. The management of patients faces many challenges though the combination of nonoperative and operative strategies are in use. There is paucity of publication locally, hence the need for this study. Objective: To evaluate the surgical management of patients with diabetic foot ulcers at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Methods: A cross sectional study done in the surgical wards and the diabetic clinic of MTRH between 1st May 2017 and 31st April 2019, involving census of 89 adult patients with diabetic foot ulcers who met the inclusion criteria. Characterization of these patients had been previously done by same team of authors. Relevant data regarding the management with particular interest in treatment modality, and association between some risk factors (peripheral neuropathy, body mass index and glycated haemoglobin) and treatment modality was collected using interviewer administered questionnaires. Data was then cleaned, coded and analyzed using statistical package (SPSS version 19). Presentation was in diagrammatically and in prose formats. Results: The 89 patients were graded using Wagner’s classification: grade 1- 4 were 19, 30, 28 and 12 respectively. Debridements were done to 78 (87.6%) while amputation to 11 (12.4%). Of factors associated with surgical management (debridement and amputation), statistically significant findings (p<0.05) were for peripheral neuropathy (pricking and weakness). However, there was no statistically significant association between body mass index and surgical treatment as well as glycated haemoglobin and surgical treatment. Conclusion: Grade 2 DFUs was the commonest. Debridements were done in most patients, while eleven patients with grade 4 were done amputations. Association between surgical management and peripheral neuropathy was statistically significant. Recommendations: Creating public awareness, early identification of DFUs in patients and appropriate management to salvage the foot are necessary to prevent progression into stage requiring amputation. Multidisciplinary team approach should be adopted.