Abstract
Major amputation remains the default response to gas-forming soft tissue infection of the lower limb in diabetic patients across Sub-Saharan Africa, despite its devastating functional and economic consequences in settings with minimal prosthetic services. We report a prospective cohort study of 20 such patients who underwent primary decompressive fasciotomy at a tertiary centre in Dakar, Senegal. Overall limb salvage was achieved in 75% (15/20), and in-hospital mortality was zero. Among nine patients ultimately requiring amputation, the planned level was downstaged in 78%, including one patient initially assessed for hip disarticulation who underwent lower leg amputation. Preoperative vascular status was the decisive predictor: salvage reached 91% with good arterial perfusion versus 0% in mediacalcosis (Mönckeberg's arteriosclerosis) (p < 0.01). Therefore, decompressive fasciotomy, being a less invasive, inexpensive, and technically accessible procedure, should precede amputation in every diabetic patient with gas-forming lower limb infection and preserved arterial flow.
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