Diabetic Foot Ulcer (DFU) Patients

in Cipto Mangunkusumo Hospital,

a Tertiary Health Care Center

Dr. R. Suhartono, SpB(K)V

Vascular and Endovascular Surgeon
Cipto Mangunkusumo Hospital/
Faculty of Medicine – University of Indonesia
 Patients’ Demograpic
60 40
37
51 35
35
50
46
30 29 <40 yo
40
35 41-50 yo
33 25
21 51-60 yo
30
20
61-70 yo
20 Male Female
15 13 >70 yo

10 10 8
7
5
5 4 4
0
July-Dec 2013(86 pts) Jan-June 2014 (79 pts)
0
July-Dec 2013 Jan-June 2014
 Blood Glucose Control

67

July-Dec 2013

12

Uncontroled
Controled

54

Jan-June 2014

22

0 10 20 30 40 50 60 70 80
 Albumin Level

57

July-Dec 2013

25

<3
>3

58

Jan-June 2014

21

0 10 20 30 40 50 60 70
Infection in Diabetic Foot
July - December 2013 January - June 2014

6,7%
12,
15%

67,
85%
80,
93%

Non-infected Wound
Non-infected
Wound Infected Wound
1. Mr. RS 54y.o
DFU + Gangrene 2nd and 3 rd digit of the right foot +PAD
FI : gr 2, I: gr 2, W: gr 2
Risk of Amputation : High
Benefit of Revasc : High
Lab : WBC : 18.800
Blood glucose : 377
2. Mrs SR, 50 y.o
ALI BILATERAL DUE TO AORTOILIAC DISEASE +CHF Fc II + SEPSIS
Lab: WBC: 16.600
BG: 114
Ur/Cr: 96/2.3
Alb: 2.4
• Total occlusion
abdominal aorta until
right iliac artey and until
left dorsal pedal artery

FI : gr 3
I : gr 3
W : gr 0
Risk of Amputation : High
Risk of Revasc :
High
AFTER 1 MONTH: Patient pass away due to CHF +
ARDS
3. Mr. H, 69 y.o
Aortoilliac disease + left DFU (post
choppart amputation)
Lab : WBC : 8.950 , BG : 149
• Severe stenosis of distal
aorta until left femoral
artery

FI : gr 2
I : gr2
W : gr 2
Risk of Amputation : High
Benefit of revasc ? : High
AFTER ANGIOPLASTY
4.Mr. BHT 72 y.o
Gangrene of the left leg and foot +Total
occlusion of distal aorta + sepsis
Lab : WBC : 18.200, Alb : 2.2, BG :
210
Total occlusion of distal abdominal aorta

FI : gr 3
I : gr 3
W : gr 3

Risk of amputation : High

Benefit of revasc : High
Above Knee Amputation
Pass away  COD : Prolong sepsis
 Stenosis post tibial artery,
peroneal artery, anterior
tibial artery bilateral

FI : gr 1
I : gr 1
W : gr 1

Risk of amputation : very

low
Benefit of revasc : Moderate
 6. Mrs. GLS 78 y.0
Acute Limb Ischemia +Sepsis

WBC: 18.700
Ddimer : 400
Fibrin: 497
Procalcitonin : 3.8
W: gr 3
I : gr 3
FI: gr 3
Risk of amputation :
High
Benefit of revasc:
High
Right Amputation Above the knee of the leg
Post op day 2: Patient pass away
COD: MODS , Irreversible Septic Shock
 Surgical Intervention
Bypass Bypass
femorofemor femorofemor Minor
al,1,2% al,2,3% Amputation,1
6,20%

Minor
Amputation,2
1,29%
Major
Amputation,6
,7%

Redebrideme
Major
nt,44,61%
Amputation,6
,8%
Redebrideme January - July 2014
July - December 2013 nt,57,70%
 Endovascular Intervention
25

20
20

15

SFA
BTK
10
10

5
5

0
July-Dec 2013 (13 pts) Jan-June 2014 (25 pts)

Total Intervention : 38 patients

 Length of Stay
• July – December 2013:
– Mean 35 days
– Minimum 8 days, maximum 76 days

• January – June 2014:

– Mean 30 days
– Minimum 12 days, maximum 60 days
 Summary

• Diabetic foot problems in Indonesia:

– High infection incidence
– Younger patients
– Poor metabolic control of blood glucose level &
albumin
– Longer length of stay