Introduction: Diabetes mellitus (‘DM’) in the burns population poses a clinical challenge due to altered wound healing and vascularity. In our previous 5-year audit we showed high rates of operations (78%), amputations (23%), and longer lengths of stay in patients with DM who were admitted. The objective of this study was two-fold: to examine the rate of amputations and concomitant infections in all patients with DM; and two, to compare these rates with a matched control.
Methods: This study was a retrospective review clinical audit. Descriptive statistics were used to assess the patient, injury, and outcome characteristics. Matched controls were for age, gender, and TBSA (within +/-5%).
Results: A total of 657 patients with a history of diabetes mellitus were seen in the Western Australian Statewide Adults Burns Unit in Perth, WA. Most patients were male (479, 72.9%) with an average age of 63 (21.8 to 98), and diagnosed with Type II diabetes (604, 91.9%). The most common burns etiology was contact (238, 36.2%) with an average TBSA of 2.1% (0.01-68.1%). There was a total of 36 amputations (5.5%) with the majority in the lower extremity (33, 91.7%) with a downtrend in the number of amputations over the past two years (2 of 36, 5.6%). There was a high rate of concomitant infections (26, 72.2%). A matched control group showed a significantly lower infection rate and number of amputations.
Conclusion: A change in practice included the adoption of a multimodal approach, strict glycemic control, negative pressure wound therapy, and a low threshold to treat with antibiotics. With this approach, we have found that the overall rate of amputations in this cohort is low and continues to be downtrending.