Multidisciplinary Limb Salvage in a Threatened Diabetic Foot: A Narrative Review of Time to Referral and Amputation-Free Survival
DOI:
https://doi.org/10.5281/zenodo.22227826Keywords:
Diabetic Foot Ulcer, Limb Salvage, Multidisciplinary Care, Amputation, Time to ReferralAbstract
A diabetic foot ulcer is a small wound with a mortality rate. It precedes most lower limb amputations in people with diabetes, and
the five-year survival after a major amputation is worse than for many cancers. Whether the limb is saved depends less on any
single technique than on how quickly the right several people see the foot.
Objectives: To review the published evidence on multidisciplinary limb salvage in the threatened diabetic foot: the scale of the
problem, what coordinated care changes, how much time to referral matters, and what happens after the ulcer heals.
Material and Methods: Narrative review of systematic reviews, meta-analyses, cohort studies, guideline documents and
health-economic analyses indexed in PubMed and the major diabetes, vascular and podiatry journals. No new patient data were
generated; every estimate quoted is one published by the original investigators.
Results: Diabetic foot ulcers affect approximately 18.6 million people worldwide each year and precede 80 per cent of lower
extremity amputations in people with diabetes; between 19 and 34 per cent of people with diabetes develop one in their lifetime.
Only 30 to 40 per cent heal at 12 weeks, and recurrence is 42 per cent at one year and 65 per cent at five. Multidisciplinary care
was associated with a lower major amputation rate than usual care across 18 studies (3.2 against 4.4 per cent; odds ratio 0.40,
95% CI 0.32 to 0.51). Five-year mortality is approximately 30 per cent after an ulcer and exceeds 70 per cent after major
amputation.
Conclusion: The evidence for coordinated care is consistent and the absolute difference is real but modest, and it comes from
before-and-after and cohort comparisons rather than randomised allocation. The more striking finding is what follows healing:
two in three ulcers return within five years, which means remission rather than cure is the correct frame.
Abbreviations: DFU – Diabetic Foot Ulcer, IWGDF – International Working Group on the Diabetic Foot, LEA – Lower
Extremity Amputation, MDT – Multidisciplinary Team, PAD – Peripheral Arterial Disease, OR – Odds Ratio.
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