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Predictors for Amputation in Patients with Diabetic Foot Wound
Vascular Specialist International 2018;34:109-116
Published online December 31, 2018;
© 2018 Vascular Specialist International.

Se-Young Kim1, Tae Hoon Kim1, Jun-Young Choi1, Yu-Jin Kwon1, Dong Hui Choi1, Ki Chun Kim2, Min Ji Kim3, Ho Kyung Hwang3, and Kyung-Bok Lee1

1Department of Surgery, Seoul Medical Center, Seoul, Korea, 2Department of Orthopedic Surgery, Seoul Medical Center, Seoul, Korea, 3Department of Radiology, Seoul Medical Center, Seoul, Korea
Correspondence to: Corresponding author: Kyung-Bok Lee, Department of Surgery, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, Seoul 02053, Korea, Tel: 82-2-2276-7871, Fax: 82-2-2276-7880, E-mail:,
Received September 26, 2018; Revised October 24, 2018; Accepted October 26, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Diabetic foot wound (DFW) is known as a major contributor of nontraumatic lower extremity amputation. We aimed to evaluate overall amputation rates and risk factors for amputation in patients with DFW.

Materials and Methods

From January 2014 to December 2017, 141 patients with DFW were enrolled. We determined rates and risk factors of major amputation in DFW and in DFW with peripheral arterial occlusive disease (PAOD). In addition, we investigated rates and predictors for amputation in diabetic foot ulcer (DFU).


The overall rate of major amputation was 26.2% in patients with DFW. Among 141 DFWs, 76 patients (53.9%) had PAOD and 29 patients (38.2%) of 76 DFWs with PAOD underwent major amputation. Wound state according to Wagner classification, congestive heart failure, leukocytosis, dementia, and PAOD were the significant risk factors for major amputation. In DFW with PAOD, Wagner classification grades and leukocytosis were the predictors for major amputation. In addition, amputation was performed for 28 patients (38.4%) while major amputation was performed for 5 patients (6.8%) of 73 DFUs. Only the presence of osteomyelitis (OM) showed significant difference for amputation in DFU.


This study represented that approximately a quarter of DFWs underwent major amputation. Moreover, over half of DFW patients had PAOD and about 38.2% of them underwent major amputation. Wound state and PAOD was major predictors for major amputation in DFW. Systemic factors, such as CHF, leukocytosis, and dementia were identified as risk factors for major amputation. In terms of DFU, 38.4% underwent amputation and the presence of OM was a determinant for amputation.

Keywords: Diabetic foot wound, Amputation, Peripheral arterial occlusive disease, Risk factors

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