Non-Traumatic Lower Extremity Amputation (The Common Causes)……………………………………….
Kerbala Journal of Medicine,
Volume 2, Issue 4, Pages 479-485
Lower Extremity Amputation (LEA): is defined as the complete loss in the transverse
plane of any part of the lower limb, and categorized as(1): (1) Minor (i.e. at or below the
ankle joint). (2) Major (i.e. above the ankle joint).
Method & patients:The aim of this study is to determine the common causes of non-traumatic
L.E.A. It is a retrospective study of (138) patients, with 149 lower limbs treated by amputation
for different causes in Al-Hussein general and Al-Abass private hospitals in Karbala, in the
period between Sep, 2002 through Sep, 2007, excluding cases due to trauma, military and army
Results: Diabetes is a major risk factor for LEA and form (78.5 %) of cases with different
presentations. The important risk factors were infected deep ulcer in neuropathic foot (26 cases),
late stages of infected foot (38 cases) and arteriosclerosis (51 cases) presented as gangrene in one
toe or more. Patients with loss of protective sensation, loss of education and preventive program
and neglect the ulcer or mild injury to complicate and presented in late stages end with
amputation. Non-diabetic peripheral vascular disease (17%) is the 2nd cause; it is either
arteriosclerosis or Beurger disease. Other rare causes were primary malignant bone tumor (3%)
and other miscellaneous causes such as non-diabetic chronic osteomylitis (1.5%). Minor
amputations were 61 limbs (i.e.41%) but major amputations were 88limbs (59 %). (19) Patients
from diabetic group had history of previous major amputations in the same side or other limb,
and (11) of them done during the study period, so considered as risk factor.
Conclusion:Diabetic foot is the most common cause of LEA, and reduction in the number of
amputation can be achieved if the patient is directed to foot-care programs. The diabetics need
comprehensive care, included good endocrine control, education on endocrine control, yearly
foot screening by multidisciplinary foot-care team. The patients should instructed to pay
meticulous attention to foot wear, foot hygiene, to cutting nail and daily foot inspection to
reducing the risk of an injury that can lead to heel ulcer and amputation.
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