Prevalence of Leg Amputations is Still High!
The number of lower limb amputations from vascular causes is still increasing. The rise is due to increases in atherosclerosis and diabetes. In contrast, limb amputations caused by non-vascular causes remain level.Despite the fact that the last 20 years have seen major developments in healing of foot/leg tissue loss driven by innovations in assessment and treatment, the development of modern wound care dressing materials and technological advances in high-compression bandaging where indicated, numbers of lower limb amputations are still high.
The relentless increase in lower limb amputations is likely to be due to changes in demography and increased risks of concurrent chronic illnesses like diabetes. Increasing numbers of the elderly in the population will lead to a corresponding increase in numbers of patients with leg/foot tissue loss, as the highest prevalence occurs in the most elderly. Already the number of leg amputations among 65+ years old patients has nearly doubled since 1997.
The WHO has recognised that there is a global 'epidemic of obesity' and the prevalence of type 2 diabetes is rising in parallel. US studies report a prevalence of 4% in 2000 which is projected to increase to more than 7% in 2050. Studies from the UK suggest a prevalence of diagnosed diabetes of about 7% for adult men and 5% for adult woman by the year 2010. This would equate to approximately 3 million. people with diagnosed diabetes.
Amputation is one of the most feared complications. The impact on the patient's life is immense and survival is bleak, with a 2-year mortality up to 50%. There is an urgent need to reduce amputation rates, which vary considerably globally and nationally.
The Challenge!
Clinicians and primary care services feel a need to unravel the aetiologies of leg/foot tissue loss in order to diagnose, prevent and manage leg/foot tissue loss more effectively. The aetiologies of leg/foot tissue loss are more complex and hence challenging than previously recognised, which may be a consequence of both increasing ulcer chronicity and age. Patients can have leg/foot tissue loss with a single aetiology or with multiple causes. There are more than 40 reported causes of leg/foot tissue loss. Hence, day to day diagnosis is complex and challenging.
Only an interdisciplinary management approach which also spans the acute and community boundaries will step change prevalence. A 11-year survey in diabetic amputation rates conducted between 1995 and 2005 at Ipswich Hospital showed a significant decrease in lower leg amputation rates following the introduction of an interdisciplinary foot team. Over the survey period, the incidence of all amputations fell by 40%, among people with diabetes by 70%.
Disease Awareness among patients with concurrent chronic diseases is still low. There is very limited awareness regarding first indications of 'ileg/foot tissue loss' and severity and potential acute nature of 'leg/foot tissue loss among patients.
The Summit
Launching the first interdisciplinary consensus summit addressing definitions, diagnosis, prevention and definitive management of leg/foot tissue loss covering all vascular and non-vascular causes.
Based on the learning's from the 2008 summit we will launch clinical awareness programs empower patients and reduce the disease burden on them.
More
