Lower limb burns in diabetic patients: An update on implications, outcomes and management

Dr Jessica Ibbeson1, Dr Helen Douglas, Professor Fiona Wood

1State Adult Burns Service, Fiona Stanley Hospital, Murdoch, Australia

Abstract:

Introduction

The most common site of burn in patients with diabetes mellitus (DM) is the lower limb (Goutos et al 2015; Cianci et al 2013; Tracey et al 2020).  The micro and macrovascular complications associated with DM not only increase the risk of sustaining a lower limb burn but also result in an increase in complications and length of hospital stay in this cohort of patients  (Goutos et al 2015; Sayampanathan 2016).

Methods

Data for all patients admitted under the State Adult Burns Service from 2015 – 2021 with isolated lower limb burns, and diabetes listed as a comorbidity, was collected retrospectively from electronic patient records.

Results

Ninety-five patients were admitted to the State Adult Burns Service between 2015-2021 with isolated lower limb burns and diabetes. Seventy-three patients required operative management, with 23% undergoing amputation. Twenty-six percent required re-operation, 42% of re-operations were amputations.

The mean TBSA was 1.11 (range 0.03-3.25), and the length of stay in our cohort was 8.67 days, significantly longer than predicted for an injury of this size in our unit.

Discussion

These findings are in line with our previous audit presented in 2018 and demonstrate that lower limb burns in patients with diabetes result in a significantly longer length of stay, re-operation and amputation rate. Management by a multidisciplinary team is essential to ensure optimal care of this complex cohort of patients. An algorithm for effective early management of these patients will be discussed.

References

Cianci P, Slade JB, Sato R, Faulkner J. Adjunctive hyperbaric oxygen therapy in the treatment of thermal burns. Undersea Hyperb Med. 2013;40(1):89-108.

Goutos I, Nicholas RS, Pandya AA, Ghosh SJ. Diabetes mellitus and burns. Part II- outcomes from burn injuries and future directions. In J Burn Trauma. 2015;5(1):13-21.

Sayampanathan AA. Systematic review of complications and outcomes of diabetic patients with burn trauma. Burns. 2016;42:1644-51.

Tracy LM, Rosenblum S, Gabbe BJ. Burns Registry of Australia and New Zealand (BRANZ) Annual Report 2018/19. Monash University. 2020. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.


Biography:

Jessica Ibbeson is a Surgical Service Registrar working in the Plastic Surgery and Burns Units at Fiona Stanley Hospital.

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