The records of the inpatients admitted to the Department of General Surgery in a tertiary care teaching hospital were retrospectively analysed. The study period was from June 2013 to December 2013. The following were the inclusion and exclusion criteria;

There were 123 patients who were included in this study during this period. There were 101 males (82.11%) and 22 females (17.89%), the male: female ratio being 4.6:1. One hundred tweleve patients (91.06%) were affected with type 1 diabetic foot complication, 3 patients (2.44%) with type 2 and 8 patients (6.5%) with type 3 diabetic foot complications [Table/Fig-2]. Majority of the males (74.8%) were affected with type 1 diabetic foot complications.Fifty three patients (43.09%) had right foot involvement and 70 patients (56.91%) had left foot involved. Only one patient had both the feet involved.

Wet gangrene (35.7%) was the most common type 1 diabetic foot complication [Table/Fig-3,4] followed by necrotizing fasciitis (27.67%). Overall, debridement (53.65%) was the most commonly performed procedure [Table/Fig-5]. It was also the most common surgical procedure done in type I complications followed by toe amputations.

[Table/Fig-4]:

Showing wet gangrene of the left foot. It is type 1 diabetic foot complication

Among the three patients belonging to type 2 DF complications, two patients had peripheral arterial disease with extensive gangrene and the third patient had ischaemic heal ulcer, which was not salvageable. Eight patients belonged to type 3 complications [Table/Fig-6],six patients had non healing infected ulcer with osteomyelitis, three of whom underwent toe amputation, two debridements and one metatarsal amputation. The remaining two patients underwent major amputations due to mixed complications consisting of infective gangrene, deformed foot associated with peripheral arterial disease. In this study, 20 patients (16.26%) underwent major amputations out of which 15 patients (12.2%) were having type I diabetic foot complications. There was one death in a patient with necrotising fasciitis in our study.

[Table/Fig-6]:

Showing a case of type 3 diabetic foot complication. Patient had non healing ulcer with infective gangrene and underlying peripheral vascular disease

Diabetic foot is one of the most dreaded complications of diabetes as it may lead to amputation, a devastating consequence [8]. The burden of diabetic foot ulceration is heaviest in the resource poor parts of the world where the incidence is quite high [9].

Wagner’s classification has been used commonly to describe the diabetic foot ulcers [2,4,9] which is based on wound depth and the extent of tissue necrosis. Several authors have noted a disadvantage of this system, that it only accounts for wound depth and appearance and does not consider the presence of ischaemia or infection [10,11]. University of Texas Classification though includes ischaemia and infection it does not include any other DF complications like Necrotising fasciitis and Osteomyelitis.

The new Amit Jain’s classification was chosen as it includes almost all DF complications [6,7]. Our study shows that type 1 diabetic foot complications are the most common type of complications seen in the hospitalized patients. Statistics show that around 40% of inpatients admitted with diabetic foot problems, will require some form of amputation [12]. In our study, 46.34% required some form of amputation, with toe amputation being the commonest amputation. 16.26% of the patients required major amputations which is comparable with a rate of 9-24% in the literature [5,13].

Comparing our study with Jain et al., series [14], wet gangrene was the most common type 1 diabetic foot complication and 12.2% of the major amputations occurred in this group. while, abscess was the commonest type 1 diabetic foot complications in Jain et al., series, and 8.89% of the patients underwent major amputations in this group [7].

Majority of the patients (n=112) belonged to type 1 DF complication, 13.39% patients underwent major amputation, with one death in the patient with NF, in this group. 25% of patients underwent major amputation in type 3 while all the three patients [100%] belonging to type 2, underwent major amputation though there were no amputations in type 2 and 3 patients in the Jain et al., series [14].

Amit Jain’s classification could thus include all the diabetic foot complications in the various subgroups, that were encountered during the study period in a simplified way. It could possibly be a good teaching and communicative tool and may help in timing the management.

In our study, as per Amit Jain’s classification type 1 diabetic foot complications were the most common complication encountered by the treating surgeon. Debridement was the most common procedure performed in type 1 complication followed by toe amputation. Major amputations occurred more frequently in type 1 diabetic foot complications. As this is a new classification, few more studies will be required to predict the clinical outcome.