Amputation due to diabetes can be avoided, Dr Ravul Jindal

Chandigarh, April 6, 2016: The tragedy of a person getting to know that his or her amputated leg could have been saved is not mere physical loss but is damaging, emotionally, financially too. “It is often said that a patient with gangrened diabetic foot has to go through an amputation. Diabetic foot is one of the main reasons for diabetic patient admissions and has a very high morbidity and mortality. More than 95 percent of these surgeries for amputation can be prevented with proper education and timely treatment,” said Dr. Ravul Jindal, Director Vascular Surgery, Fortis Hospital Mohali, while addressing mediapersons on the eve of ‘World Health Day’ special press meet organized on Wednesday. The theme of ‘World Health Day’ this year is ‘Beat Diabetes’.
Talking about the patient's history and their emotional loss, Dr. Jindal said, “In the last two years there were more than 200 patient that came to Fortis hospital with an amputated leg due to diabetes and when they got to know that the amputation could have been avoided, and the leg could have been saved, and if they had the right information at the right time, it’s shocking for them”.
Dr. Jindal said that there are more than 60 patients that visit his OPD with a diabetic foot every month. A sedentary lifestyle, lack of physical activity, obesity, stress and consumption of a diet rich in fat, sugar and calories, is responsible for the sharp increase in the diabetic population, Dr Jindal opined. Diabetes renders foot lesions more susceptible to gangrene. People from the lower strata of society and those living in rural areas run a high risk of losing their limbs due to lesions. Education and prevention play a pivotal role in awakening masses.
Warning diabetics to remain cautious over any kind of foot lesions, Dr Jindal said that even cases of fissures, abscesses, cellulites, ulcers, claw toes and Charcot's joints need to be watched carefully. “Specialized treatment like angioplasty or bypass for arterial blockage is a major deterrent too. When done timely, it saves limb, and in some cases - life too,” he added.
Dr Jindal said treatment of diabetic lesions requires surgical cleaning of the infected tissue, and restoration of blood flow to the foot. Treatment requires an aggressive multidisciplinary approach, with co-operation between diabetologists, vascular and plastic surgeons. As diabetics pose a major cardiovascular risk while open surgery so Infrapopliteal Percutaneous Transluminal Angioplasty (PTA) is quite an established procedure and is indicated in patients with critical limb ischemia (CLI). There are some patients in this group who had blockage in the vessels that are behind knee and are very difficult to treat percutaneously.
“We used to prefer to do by pass on this group of patients. But now with latest availability of newer technologies like Supera Stent we can treat even these patients without giving major cuts. We have treated eight such patients with successful results and all these patients foot could be saved from amputation. This technology was used in North India for the first time here 2 months back and we are very happy with the developments,” he said.
Supera stent is a new innovative technology in the stent that can be placed in arteries which are crossing the joints. They are so flexible that the incidences of their blockage and stent fractures are quite less giving doctors advantage to treat these patients without open surgery.
He said that patients with CLI are typically elderly with multiple co-morbidities and limited life expectancy and therefore, a procedure, which is minimally invasive with reduced morbidity and mortality but lesser long-term patency, may be more appropriate and effective.
Renowned Singer Malkit Singh's Father Dharam Singh (80yrs) was also suffering from gangrene in the left foot, shared his experience of admission in the hospital & successful treatment by Dr Jindal. Another patient Mr Dev Rattan Sukhija ( 68 years) was also suffered with Right Diabetic Foot also got treated with the same technique to prevent limb amputaion.
Symptoms
• Diabetes causes loss of sensation and block leg arteries causing foot ulcers. While foot ulcers are main cause of amputation in diabetic patients, most of these amputations can be prevented if diagnosed early and treated in time.
• The first physical sign of diabetes is loss of circulation in feet which needs to be monitored by doctor.
• Managing blood pressure, cholesterol levels and blood glucose with regular exercises are best ways to prevent these diseases. The most common cause of amputation in diabetics is lack of blood supply and consequent lesions/ulcers or infections i.e. gangrene. And also, in patients with diabetes, pure ischemic ulcers are less common and the vast majority of ulcers are either pure neuropathic or mixed neuro ischemic.