Major amputations are on the decline locally, thanks to timely medical interventions which have caused the figures to fall by some 10 per cent in the past two years.
This is in sharp contrast to the rise that should have occurred with the surge of diabetes in the local population, which increases seventeenfold an individual’s chances of having a major amputation.
“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,” Mr Cassar said.
Major amputations are those which occur above the knee or below the knee. Anything further peripheral is described as a minor amputation, and results in lower morbidity and mortality.
More than 90 per cent of amputees in Malta are diabetic, far higher than anywhere in the world.
Diabetes decreases blood supply to the peripheries by narrowing the arteries that carry the blood and is a major risk factor for damage to the nerves in the feet, known as peripheral neuropathy.
Although the surge in diabetes over the past few years should have led to a rise in major amputations, this was not the case. There are a number of factors that contribute to the decrease in amputation numbers, the surgeon pointed out.
Three new interventional radiologists have been recruited within the health service, which are able to carry out certain angioplasties and interventions that were not done in the past. These enable blocked arteries to be opened through a relatively minor procedure, essentially delivering more oxygen to infected tissues to enable them to heal.
The other major contributor is the setting up of a combined diabetic foot clinic, which is attended by a vascular surgeon, a podiatrist and a diabetologist to identify patients at risk and treat them as early as possible.
There has also been a development of a complete vascular service, with improved equipment both in clinics and the theatre.
More importantly, the number of arterial bypasses has increased dramatically, enabling blocked parts of arteries that cannot be opened by other interventions to be bypassed with another vessel. In 2006, a total of 12 bypass procedures were carried out, which increased to 56 in 2009.
On top of all this, podiatrists are beginning to assess and screen diabetics in the community, essentially advising on wearing appropriate footwear and necessary interventions before the real problems start. The plan is to expand that into a national screening programme.
A task force has also been set up for amputations, which includes podiatrists, social workers, physiotherapists, orthotists, prosthetists and surgeons.
Despite the marked decrease in major amputations, which carry a higher rate of morbidity and mortality, the number of minor amputations has increased.
In 2003, the national health service carried out 83 minor amputations, while last year a total of 218 were carried out.
“This means we’re catching them earlier,” Mr Cassar said, emphasising that early intervention nips the problem in the bud.
Losing a part of the body has a major impact on lives and an association for amputees is making the difference by offering support to patients.
Moreover, various groups of professionals work closely with these patients before the amputation.
For example, physiotherapists assess them before, giving them exercises that will help them after the procedure.
Although a lot of improvement has been made, Mr Cassar pointed out, major amputations still present a serious challenge and a multidisciplinary approach is needed to help the patient recover from such an ordeal.