趙啟明醫生醫務所         Dr Leo Chiu, Central Vascular Clinic

The prevalence of diabetes (DM) in Hong Kong is on the increase.  More than 12% of the 7 million people of Hong Kong are older than 65-years old.  About 14% of those aged over 65 have diagnosed DM.  Our survey revealed that 13% of patients aged over 40 attending the diabetic clinic have evidence of lower limb ischaemia.  Two third of patient with the most advanced ischaemia (critical limb ischaemia) have underlying diabetes.  Diabetic patient often have arterial obstruction at the leg level.  Fortunately, foot arteries are almost invariably remain open, which allows for distal arterial reconstruction. Our experience concurred with most published data that arterial reconstruction is almost always possible and usually successful in patients with diabetes.  Distal arterial reconstruction to the foot level has been demonstrated to be a technically feasible and highly effective treatment to save the leg of diabetic patient with infected ulcer or gangrene. At risk foot Diabetes patients have compromised defense to infection and the long-term effects of diabetes are damage to the eyes (retinopathy), nerves (neuropathy) and arteries (arteriopathy).  The nerve problems cause foot deformity and decreased sensation. These predispose to foot injury.  In the event of co-existing poor blood supply the injury cannot heal.  In diabetic patient the ulcer quickly become infected and lead to spreading infection and gangrene.  In addition, diabetic patients often have poor vision (retinopathy) which deprived them the ability to detect foot problems at an early stage.  The key to prevent amputation in diabetic patients is regular foot screenings for the detection of at risk foot and early recognition of foot lesion.  Diabetic patients with foot ulcer should have the blood supply evaluated as soon as possible.  Spreading foot infection in diabetic patient with insufficient blood supply is a medical emergency.  Do not delay for conservative treatment, early surgical intervention is often the only opportunity to save the limb and life.  ► Back to top