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Necrotizing Soft-Tissue Infections in the Feet of Patients With Diabetes: Outcome of Surgical Treatment and Factors Associated With Limb Loss and Mortality

La Paloma Hospital, Las Palmas de Gran Canaria, Spain, javiaragon{at}telefonica.net

Yurena Quintana-Marrero

La Paloma Hospital, Las Palmas de Gran Canaria, Spain

Jose L. Lázaro-Martínez

Complutense University Podiatric Clinic, Madrid, Spain

Maria J. Hernández-Herrero

La Paloma Hospital, Las Palmas de Gran Canaria, Spain

Esther García-Morales

Complutense University Podiatric Clinic, Madrid, Spain

Juan V. Beneit-Montesinos

Complutense University Podiatric Clinic, Madrid, Spain

Juan J. Cabrera-Galván

La Paloma Hospital, Las Palmas de Gran Canaria, Spain

The aim of this study was to analyze the outcomes of treatment of necrotizing soft-tissue infections (NSTIs) in the feet of diabetic patients and to determine factors associated with limb salvage and mortality. A retrospective study of a consecutive series of 145 diabetic patients suffering from NSTIs treated in the Diabetic Foot Unit, La Paloma Hospital was done. NSTIs were classified as necrotizing cellulitis if it involved the subcutaneous tissue and the skin, as necrotizing fasciitis if it involved the deep fascia, and as myonecrosis in those cases where muscular necrosis was present. In the necrotizing cellulitis group (n = 109), 8 (7.3%) major amputations were performed. In the necrotizing fasciitis group (n = 25), 13 (52%) major amputations were undertaken. In the myonecrosis group (n = 11), 6 (54.5%) major amputations were performed. Predictive variables related to limb loss were fasciitis (OR = 20, 95% CI = 3.2-122.1) and myonecrosis (OR = 53.2, 95% CI = 5.1-552.4). Predictive variables of mortality were age >75 years (OR = 10.3, 95% CI = 1.9-53.6) and creatinine values >132.6 µmol/L (OR = 5.8, 95% CI = 1.1-30.2). NSTIs of the foot are an important cause of morbidity and mortality in diabetic patients.When fascia and/or muscle are involved, there are significant risks of major amputation.

Key Words: diabetic foot • necrotizing soft-tissue infection • diabetic foot infection • foot ulcer • necrotizing fasciitis • myonecrosis

The International Journal of Lower Extremity Wounds, Vol. 8, No. 3, 141-146 (2009)
DOI: 10.1177/1534734609344106


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