MANAGEMENT OF DIABETIC FOOT ACCORDING TO WAGNERʹS CLASSIFICATION AND FREQUENCY OF DIABETIC FOOT DISEASE IN OTHER FOOT A STUDY OF 98 CASES

Objective: To find the grade wise distribution of diabetic foot ulcer, the best surgical management for different grades of diabetic foot ulcer and factors that can decrease the rate of morbidity and mortality in these patients. Material and Methods: The study was conducted in Surgical "A " Unit, PGMI Lady Reading Hospital, Peshawar, Pakistan from April 2007 to April 2008. 98 patients with diabetic foot disease were included. Detailed history, clinical examination and investigations were recorded. Lesions of the diabetic foot were graded according to the Wagner classification and appropriate medical and surgical treatment carried out. Results: Fifty nine patients were males and thirty nine were females. Common age group was above 40 years and mostly between 40-60 years. Ninety nine percent of the patients were suffering from Type II Diabetes Mellitus. In more than half (58.16%) of the patients family history of diabetes was absent. Eleven patients had grade 1, 15 grade 2, 19 grade 3, 32 grade 4 and 21 patients had grade 5 lesions. Staphylococcus aureus was the commonest organism (74.28%) isolated. On Doppler studies of the patients 61.9% patients were found to have stenosed leg vessels (Popliteal, Anterior tibial and Posterior tibial). Other co-morbid conditions like hypertension were found in 75 patients, ischemic heart disease in 40 patients and renal disease in 28 patients. Seven patients were treated with conservative antibiotics alone, 22 had incision and drainage, 28 had debridement and dressing, 38 needed amputations of different types and 2 patients needed skin graft for chronic ulcer. Disease in other foot was noted to be in 50 patients, 28 with grade 0 and 22 with grade 1. Conclusion: In patients of Diabetic foot disease all grades were seen. Lesser grade lesions responded well to conservative treatment with antibiotics while higher grades needed incision and drainage, debridement and dressing and even amputation. Early hospital admission, good glycemic control, appropriate medical and surgical treatment along with patient councelling in foot care can decrease morbidity and mortality due to the complications of diabetic foot disease.