Prediction of stump healing in lower limb amputation: a narrative review
Abstract
Both types of diabetes, as well as different forms of acquired diabetes, are associated with diabetic peripheral neuropathy. Diabetic foot ulcers (DFU) is the condition most commonly related to somatic peripheral neuropathy, often leading to gangrene and limb amputation. Independent from large-vessel disease, sensory loss may result in DFU development and even amputation. The crucial part of any lower limb amputation is the stump healing process, which represents the central goal of postoperative management. Despite the importance attributed to this process, a standard set of guidelines regarding efficient healing methods is yet to be formulated. Health professionals are faced with the challenge of assessing the different risk factors and deciding which has a greater influence on the stump healing rate. There is currently an insufficient number of studies regarding factors effecting lower limb amputation. The main purpose of this review is to discuss the markers that can be helpful in the prediction of stump healing in patients who have undergone lower limb amputation.
Diabetes is often accompanied by macrovascular complications.1 The morbidity and mortality rates among patients with diabetes are significantly increased by vascular disease which, together with diabetes, is responsible for the greatest number of deaths on a global level.2 Only two thirds of diabetic foot ulcers (DFU) eventually heal without surgery.3 Up to 28% may result in some form of amputation.4 Research has suggested a poor prognosis for individuals who have had major amputation. For instance, Thorud5 estimated that only about half of individuals with major amputation lived for more than two years following the procedure. Mortality in patients who had a non-traumatic lower limb amputation after 30 days and one year were 30% and 54%, respectively.6 Similarly, Ikonen et al.7 observed that 68.3–78.7% of people with diabetes who had undergone a first major amputation died within five years of the intervention.
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