Incidence and causes of lower-limb amputations in a tertiary care center: Evaluation of the medical records in a period of 2 years

Aims: The aim of the study is to outline the incidence, patterns and causes of lower limb amputations among patients attending a tertiary care center in Mangalore, India. Methods: This is a retrospective study which was done at tertiary care center in Mangalore, India., from June 2016 to May 2018. Data was collected from the medical records online system of the hospital. Search will be made using search words like limb amputation, gangrene, diabetes mellitus, PVD, wound infection, wound dehiscence and wound debridement. The following parameters of all the patients who had lower limb amputation (LLA) during this period were recorded: Age, sex, indication for amputation, level of amputation and complications. Incidence rates were calculated using the number of discharges for diabetes and non-diabetes related lower extremity amputations as the numerator and estimates of the resident population with and without diabetes as the denominator. Results: Over a period of 24 months, 243 LLAs were performed. Age of the patients ranged from 20 to 70 years with an average age of 53.5 years. 81.89% of the amputees were males. Diabetic foot complications were the most common indication for LLA in our series. Followed by peripheral arterial occlusive disease and also there were a few cases of trauma and rarely tumors. Toe disarticulation was the most common type, followed by transtibial amputation and transfemoral. Infection was the most common complication that involved 64 amputation stumps, followed by wound dehiscence which occurred in 11. Discussion: In limb amputations, the indications are many and the pattern varies from place to place [15, 16]. The general trend usually is PVD being the leading cause in the developed countries because of increasing life expectancy and sedentary life style. Males are always at risk of trauma, especially in the developing countries where male population work outside and thus exposed to the accidental hazards, moreover, males are more prone to risk factors for PVD like cigarette smoking and tobacco chewing. An early minor amputation can prevent a later major amputation [25]. Thus, minor amputations may reflect improved quality of care with earlier intervention; consequently preventing the progression from minor to major amputation