Lower Limb Amputation at the 34 Military Hospital in Freetown, Sierra Leone: Causes and Indications.
AbstractThe global prevalence of diabetes mellitus is increasing substantially. This overall increment leads to the growth in the number of individuals with diabetic complications including lower limb amputation. In low-income countries like Sierra Leone, lack of access to adequate health care, poverty and social stigma attached to “amputation” all prevent people from seeking early medical treatment for diabetic foot. The purpose of this study was to document the causes and indications of lower limb amputations and to make appropriate recommendations to the health sector of Sierra Leone. This retrospective study was conducted at 34 Military Hospital, one of the major referral hospitals in Freetown, between January 2011 and December 2014. A team of medical staff was trained to extract data. The operating theatre and ward case records were searched for information (age, gender, cause and indication for amputation) of all the patients who underwent amputation during this period. The findings were statistically documented in tables. Twenty-seven patients (24 males and 3 females) were involved in the study. The age distribution was 15-65 years (Mean 43). Majority (77.7%) of the patients presented with gangrenous and infected diabetic feet, 18.5 % was due to Road Traffic Accident and 3.8% due to complication of HIV infection. The commonest level was transtibial amputation 85% and 67% was right sided. Hospital stay was 20-50 days (average 35). There was no postoperative mortality. As most amputations were done for diabetic feet, there is need for diabetes sensitization and prevention campaigns for the general public and improvement of diabetic care for individual patients including proper glycemic control and risk factors prevention. Increased funding is required by the health sector of Sierra Leone to implement these measures. Prevention of road traffic accidents by training/educating the drivers should also be considered by Sierra Leone Road Transport Authority.
Ballard, J. L. 2003. Major lower extremity amputation in an Academic Vascular Center. Annals of Vascular Surgery, International Journal of Vascular Surgery, 17, 86-90.
Ahmed, M.E.; Mahmoud, S.M.; Mahadi; S.I.; Widatalla, A.H.; Shawir, M.A. & Ahmed, M.E. (2009). Hand sepsis in patients with diabetes mellitus. Saudi Med J. 30 (11): 1454-8.
Akanji, A.O. & Adetuyidi, A. (1990). The pattern of presentation of foot lesions in Nigerian diabetic patients. West Afr J Med. 9(1):1-5.
Centers for Disease Control and Prevention. Diabetes Surveillance, 1993. Atlanta, GA, U.S. Department of Health and Human Services, 1993, p. 87-93)
Coxon PJ, Gallen IW. Laterality of lower limb amputation in diabetic patients: retrospective audit. BMJ. 1999; 318:367.
Eskelinen E, Eskelinen A, Alback A, Lepantalo M. Major amputation incidence decreases both in non-diabetic and in diabetic patients in Helsinki. Scand J Surg. 2006; 95(3):185–9. [PubMed]
Eskelinen, E., Lepantalo, M., Hietala, E. M., Sell, H., Kauppila, L., Maenpaa, I., Pitkanen, J., Salminen-Peltola, P.,Leutola, S., Eskilinen, A., Kiviola, A., Tukiainen, E., Lukinmaa, A., Brasken, P. & Railo, M. 2004. Lower extremity amputations in Finland in 2000 and trends up to 2001. European Journal of Vascular and Endovascular Surgery, 27, 193-200.
Essoh JB, Bamba I, Dje Bi Dje V, Traore A, Lambin Y: Limb amputations in adults in an Ivorian Teaching Hospital. Niger J Ortho & Trauma 2007, 6(2):61-63.
Godlwana, L., Stewart, A. & Musenga, E. 2012. Quality of life following a major lower limb amputation in Johannesburg, South africa. South African Journal of Physiotherapy, 68, 17-
GoSL_2015_Basic Package of Essential Health Services 2015-2020.pdf
Groen RS, Kamara TB, Dixon-Cole R, Kwon S, Kingham TP, Kushner AL. A tool and index to assess surgical capacity in low income countries: an initial implementation in Sierra Leone. World J Surg 2012;
Hoffmann F, Claessen H, Morbach S, Waldeyer R, Glaeske G, Icks A. Impact of diabetes on costs before and after major lower extremity amputations in Germany. J Diabetes Complications. 2013; 27(5):467–72.
Icks A, Haastert B, Trautner C, Giani G, Glaeske G, Hoffmann F. Incidence of lower-limb amputations in the diabetic compared to the non-diabetic population. Findings from nationwide insurance data, Germany, 2005–2007. Exp Clin Endocrinol Diabetes. 2009; 117(9):500–4.
International Diabetes Federation. Diabetes atlas sixth edition update. 2014.
Kidmas, A.T.; Nwadiaro, C.H. & Igun, G.O. (2004). Lower limb amputation in Jos, Nigeria.East Afr Med J. 81(8):427-9.
Kingham TP, Kamara TB, Cherian MN, et al. Quantifying surgical capacity in Sierra Leone: a guide for improving surgical care. Arch Surg 2009; 144: 122–27.
Lazzarini, P. A., O'rourke, A. R., Russel, A. W., Clark, D. & Kuys, S. S. 2012. What are the key conditions associated with lower limb amputations in a major Australian teaching hospital? Journal of foot and ankle research,
Masood J, Irfan A, Ghulam M: Current indications for major lower limb amputation. Pakistan J. Surg 2008, 24(4):228-231.
Moxey PW, Gogalniceanu P, Hinchliffe RJ, Loftus IM, Jones KJ, Thompson MM, Holt PJ. Lower extremity amputations--a review of global variability in incidence. Diabet Med. 2011 Oct; 28(10):1144-53.
Naaeder SB: Amputation of the lower limb in Korle-Bu Teaching hospital, Accra. West Afr J Med 1993, 12:21-26.
Naraynsingh V, Singh M, Raindass MJ, Rampaul R, Ali T, Teeluck Singh S, Muharaj D (2002) Major lower limb amputations in Trinidad; a retrospective analysis.
Ndip, E.A.; Tchakonte, B. & Mbanya, J.C. (2006). A study of the prevalence and risk factors of foot problems in a population of diabetic patients in cameroon. Int J Low Extrem Wounds. Jun; 5(2):83-8.
Nwadiaro HC, Obekpa PO, Kidmas AT, Deshi PJ: Amplitudes of amputation. Nig J.Surg Sci 2000, 10:44-48.
Pendsey S, Abbas ZG. The Step-by-step program for reducing diabetic foot problems: A model for the developing world. Curr Diab Res 2007; 7: 425–8.
Pendsey SP. Understanding diabetic foot. Int J Diabetes Dev Ctries 2010; 30: 75–9.
Periard D, Cavassini M, Taffé P, et al. High prevalence of peripheral arterial disease in HIV-infected persons. Clin Infect Dis. 2008; 46(5):761–767
Rucker-Whitaker, C.; Feinglass, J.; Pearce, W.H. (2003). Explaining racial variation in lower extremity amputation. A 5 year retrospective claims data and medical record review at an urban teaching hospital. Arch Surg. 138:1347–1351.
Sié Essoh, J.B.; Kodo, M.; Djè Bi Djè, V. & Lambin, Y. (2009). Limb amputations in adults in an Ivorian teaching hospital. Niger J Clin Pract. 12 (3):245-7.
Thanni, L.O.; Tade, A.O. (2007). Extremity amputation in Nigeria—a review of indications and mortality. Surgeon. 5:213–217.
Trautner C, Haastert B, Giani G, Berger M. Incidence of lower limb amputations and diabetes. Diabetes
Care. 1996; 19(9):1006–9.
Udosen AM, Ngim Ngim, Etokidem A, Ikpeme A, Urom S, Marwa A. Attitude and perception of patients towards amputation as a form of surgical treatment in the University of Calabar teaching hospital, Nigeria. African Health Sciences 2009; 9(4): 254-257
Vamos EP, Bottle A, Majeed A, Millett C. Trends in lower extremity amputations in people with and without diabetes in England, 1996–2005. Diabetes Res Clin Pract. 2010; 87(2):275–82.
Van der Meij W: K N: No leg to stand on. Historical relation between amputations. Surgery and Prostheseology 1995, 1:1-256.
Van Houtum WH, Lavery LA, Harkless LB. The impact of diabetes-related lower-extremity amputations in the Nether¬lands. J Diab Complic 1996; 10: 325–30.
West KM: Epidemiology of Diabetes and Its Vascular Lesions.New York, NY, Elsevier, 1978
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care 2004; 27: 1047–53.