Drop in major amputations despite widespread local diabetes

“Between 2002 and 2008, the number of major amputations remained static at around 120 per year. In 2009, it was the first time the number was cut fairly significantly- down to 104 per year,” Dr Cassar said.

Over 90% of amputations in Malta are caused by diabetes, higher than anywhere else in the world. Major amputations are those which occur just above or below the knee.

Diabetes decreases blood supply to the peripheries by narrowing the arteries that carry blood, adding the chance for nerve damage in the feet, known as peripheral neuropathy.

Despite the surge in diabetes over the past number of years, there was not an increase of major amputation operations, a surgeon told the same newspaper, thanks to a number of contributing factors.

Three new interventional radiologists recruited within the heath service, are able to carry out certain angioplasties and interventions never done previously. These enable blocked arteries to be opened, delivering more oxygen to infected tissue, giving it a chance to heal.

Another contribution is the setting up of a combined diabetic foot clinic, attended by a vascular surgeon, podiatrist and diabetologist, to identify persons at risk and treat them early on.

Also, a complete vascular service with improved equipment has been developed both in clinics and in the theatre.

The number of arterial bypasses has increased, enabling blocked parts of the artery to be opened by bypassing it with another vessel. Podiatrists are starting to assess and screen diabetics in the community, giving advice on appropriate footwear, with the intention of expanding into a national screening programme.

Despite a decrease in major amputations, which bring a higher rate of morbidity and mortality, the number of minor amputations has increased, where a total of 218 operations were carried out last year, as opposed to 83 carried out in 2003.