1. Outcome the Diabetic Foot in shifa hospital on 2016.
Dr. Tayseer Altanna
Consultant vascular surgery and Diabetic Foot care.

2. D. Foot wisdom 1*Every hand can be make dressing of the wounds But not every eye can be to see the wounds *In D. Foot you get the less of damage no the best of result .

3. Since 2010 years the D. F patients admitted in vascular Deportment
*Since 2010 years the D.F patients admitted in vascular Deportment . After the head of department Al-Jadba decided that . Befor that date the D.F patients admitted in defferent departments so the shifa hospital the first in Palestine had D. foot unite .

4. Diabetes : It is Chronic -Epidemic - Costly –complex and serious diseases . D- Foot : one of the most chronic complication of DM due to neuro-angio-arthro-retino-pathy and infection . Every 10 sec detected -3- new cases of DM Every 60 sec detected -2-new cases of DF Every 20 sec detected -1- cases L.L amputation .

5. Prevalence of DM , DFP in the world Des 2016
Years
10%
170 millions
2000
15%
220 millions
2004
20%
300 millions
2008
30%
360 millions
2012
40%-50%
430 millions
2016
?????
700 – 750 mill
2030

6. The first five countries with largest of DM .
D-patients
Country
55 millions
India
52 million
China
30 million
USA
20 millions
Russian
16 millions
Germany

7. The first five counties highest of D-M patients ع
D-patients
Country
35%-40%
KSA
35%
UAE
32%
Kuwait
30%
Bahrain
28%
Qatar

8. Diabetes in Palestine : Palestine presented in the 10 postion between the Arab countries . The Diabetes in Palestine prevalent about %but the DFP about 35-40% . In West Bank the Diabetic patients In Gaza strip the Diabetic patients ,000

9. Amputation due to trauma
Amputation L.L in DM : Amputation L.L SMC % Amputation L.L SMC ,6%
Amputation due to D-F
Amputation due to trauma
In minute limbs
Every 30 minute limb
In hour limbs
In hour limbs
In day limbs
In day limb
In year ,000 limbs
In year limbs

10. D-Foot in SMC on Vascular department The total number of admission in vascular department Jan 2010 – Dec
6892 %
D-Foot cases %
Vascular cases

11. The number of admission the D-Foot patients in last seven years 3288
The number of admission the D-Foot patients in last seven years Admission DF every (year- 470) ,(mounth-39,1),(day-1,3) %
Total admission
years
8,5%
272
2010
9,7%
320
2011
12,3%
404
2012
16,7%
551
2013
15,3%
506
2014
18,5
610
2015
19%
625
2016
100%
3288
Total

12. The total number D Foot patient admission on 2016
The total number D Foot patient admission on Type 1 >>> Type 2 >>
625
Female
240 >>> 38,4%
Male
385 >>> 61,6 %
,9%
625 %

13. The age in D foot patients 625 : under 18 years ,9% 19 – 40 years ,4% 41 – 60 years % years ,7% Duration of DM in DF patient 625: 0-5y y y y above 20 y ,6% 40% % ,8% ,6%

14. The follow up in primary health care :
zzzzx
The follow up in primary health care :
625
regular %
irregular
,1%
No follow up
,65

15. Treatment of Diabetis .(DF patients) Oral 226 36% Insulin 258 41,1% mixt 106 17% no 35 5,65

16. The HbA1C level in DF patients (625) under 7 85 36% 7---8 112 18 9---10 288 46% 10 140 22,4%
The control glucose level it is vary bad ❕❕❕

17. The Scientific and education level of DF patient vary good ,5% Good ,5% Bad ,7% Vary bad ,3% Education level about 41% vary bad❓

18. The DF patients with other chronic diseases Hypertension % Cardiac diseases % Renal diseases ,6% Retino pathy % others ❓❓❓ DF patients who had history of DFU
Yes
418—67% No %

19. The most common of risk factor in D Foot ulcer it is callus formation
The most common of risk factor in D Foot ulcer it is callus formation . D Foot with callus ,3% D foot without callus ,7% So the Diabetic and D Foot patients need for education health and good follow up in primary health care .

20. Type of ulcers of D Foot patients :
Neuropathic ulcers
415….66,4%
Ischemic ulcers
210….35,6%
625

21. The D Foot ulcers presented in defferant site of the foot (625) -Toes (Fore foot) ,2% -Planter (mid foot) ,5% -Heel(hind foot ) ,3%

22. The deformation one of the most high risk of D Foot ulceration (625) -Toes deformation ,7% -charcot foot % -no deformation ,3% so the risk of D foot ulceration : 1* Neuro pathy callus , Deformation . 2* Angiopathy micro , macro angio pathy.

24. Angio-CT, angiography , angioplasty , stenting and surgical managenment : started Angio-CT of D Foot patients # conservative treatment ,9 % # Ballon-angioplasty ,7% # Stents-angioplasty ,9% # Surgical (By pass) ,5%
Normal study
3----1,1%
Patholgy (positive)
,8%
282

25. So the Diabetic patients in need angio-CT after five years duration of DM. When the distal puls palpaler by hand For -Early diagnosis -Early treatment -Follow up after that -Document

26. The common causes D-Foot ulcers 625 Internal cases neuro – angio – retino – arther-pathy and Infection . Extrnal causes. The extrnal causes of D.Foot ulcers Trauma callus Burns shoes ,4% ,3% ,3% %

27. Duration of ulcers and infection pre admission days ,8% days % 2 –weeks ,3% Greater than % 2-weaks So one of the most causes of L.L amputation it is . Late of admission Neglection

28. The Infection of D Foot patients 625: -Infected ,9% -Gangrenous ,7% -noninfected , The recurrent infection in D Foot patients about 22%

29. The most microorganism in cultures swab -pseudemonus ,8% -streptococcus ,6% -staphylococcus ,2% -E-coli % -no culture ,4%

30. We treated the D Foot patients under the Guide lines of : 1
We treated the D Foot patients under the Guide lines of : 1 *Control of blood sugar and control of infection . 2*Massive and aggressive Debridement . 3*Off-loading-reduction of pressure .

31. The Diabetic Foot patients , it is emergency case according the guide lines need admission in hospital for limb or life saving . Management of D Foot patients : -Analysis C.B.C , K.F.T -culture minim two culture ❓❓ -vascular status and A/B index , Toe index ❔❔ -Angio- CT .

32. Treatment of D Foot patients - Conservation treatment / 3,2% - Surgical debridment / 63,7% - Amputation / 33,1% Amputation due to D Foot ulcers
625
High Amputation
BKA, AKA, D.A
,4%
207
Low Amputation
Toes, TMA , SA. %

33. Amputation L. L (high) post follow up 24 3,8% Amputation L
Amputation L.L (high) post follow up ,8% Amputation L.L (high) neglected ,4% Amputation L.L (high) due to Ischemia ,1% Amputation L.L (high) due to infection and ,3% neuropathy

34. Amputation rate (high) in the seven years Amputation L
Amputation rate (high) in the seven years Amputation L.L before % in the ,4%
BKA /3,1% %
N , Amputation
T . Amputation
years
10% 27
272
2010
10,6% 34
320
2011
7,7% 51
656
2012
7,1% 36
506
2013
5,8% 32
551
2014
8,3%
610
2015
6,4% 40
625
2016
AKA /4,3%
DA /0,16%

35. What we are using in the wound dressing ❔❔ 1
What we are using in the wound dressing ❔❔ 1* dressing by NS , H2O2 ,povidin solution. 2* K-step , disinfectant , antimicrobial . 3* hydro – hypoalginat - Kaltostat , New – gel 4* silveralginat silver cell , aqua cell , Indian promogran . 5* hydro polymer polymem of all types . 6* N.P.WT , PRP , maggot therapy . 7* Follow up in D Foot clinic .

36. Results : Decrease of the L
Results : Decrease of the L.L amputation number between the 2010/11% /6,4% -Good follow up of D Foot patients during in the D Foot out clinic Recommendation: state her rule through the molt to work on the development of a comprehensive and binding plan or (project) with participation of all parties associations because the diabetes has become an epidemic spreading and it is complication elusive and terrifying result . 1*The rule of the media in all Branches for education level , Awareness and high light the seriousness of the diseases and the magnitude of the suffering and the consequent complication .

37. 2* Work on the contract conference every years for diabetes and it is complication at the level of the nation to high light , what is new and what is the problem . Conclusion : every beginning is defficult but not impossible with the will determination and wisdom to get sensitive of diabetes and it is complication , become epidemic how and in appeal to all man of science and the owners of pronouns , homeland calls them and honesty in not surrender .

38. Where do we stand today from DM and it is complication
Where do we stand today from DM and it is complication . Where are we heading today . Where stood and where we go❔❔ Say act of God will see work and his messenger and the believers the great truth of God .

39. الوحدة غايتنا