Sengkang General Hospital’s Diabetic Limb Salvage service maximises number of shoe-able patients with diabetic foot ulcers to restore their mobility and livelihood.
SINGAPORE, 13 OCTOBER 2023 - More patients with diabetic foot conditions have been able to resume their independence and mobility with the Diabetic Limb Salvage (DLS) service offered by Sengkang General Hospital (SKH).
Through a multidisciplinary care team comprising orthopaedic surgery, intervention radiology, plastic surgery, podiatry, physiotherapy and dietetics, the SKH DLS programme has demonstrated high positive patient outcomes, such as higher healing rates and reduced limb amputations and wound recurrences among patients with diabetic foot complications. This has maximised the number of “shoe-able” patients who can resume their lives and livelihoods.
Diabetes mellitus is a serious health concern in Singapore with over 400,000 Singaporeans living with the disease. The lifetime risk of developing diabetes is one in three Singaporeans. The number of those with diabetes is projected to surpass one million by 2050.1 Statistics showed that 19%-34% of patients with diabetes will develop a foot ulcer in their lifetime.2
If left untreated, diabetic foot ulcers and related complications can lead to limb amputation, drastically affecting the quality of life and livelihood for those afflicted. Singapore has one of the highest diabetes-related lower extremity amputations (LEAs) rates in the world, with almost 9 in 10 individuals who had a lower limb amputation in 2021 having had diabetes .3
The multidisciplinary one-stop service at SKH DLS focuses on wound care, reconstruction and wound prevention. The wound focused approach allows for early wound closure which reduces risk of infection, thus preventing amputations, accelerating recovery, and reducing recurrences.
Since 2019, DLS care team at SKH cared for more than 250 patients with complex diabetic foot ulcers, most of whom were on the verge of losing their limbs. The result on the improved healing of the first 50 patients (2019 to 2021) has been accepted by the Journal of Wound Care4. Success rate for the treatment can be seen in the table below:
|||SKH Diabetic Limb Service Patient Data||Before Service|
Dec 2017- Nov 2019
|DLS Service commenced|
Dec 2019 – Mar 2021
|1.||Number of diabetic foot ulcer patients treated||53||52 ||For 1 year follow up|
|2.||Rate of healing without amputation, patients can be shoe-able||68%||96%||Healing rate increased by 40%|
|3.||With a shorter duration of wound healing||111 days||77 days ||Time to heal shortened by 30% |
|4.||Amputation below the knee||9%||0%||Amputation reduced by 100%|
|5.||Recurrence rate||25%||6%||Recurrence reduced by 76%|
To summarize, with this service our patients experience:
Reduced amputations: DLS offers hope to those facing the prospect of limb amputation. A combination of promoting faster healing and better wound management has significantly cut the likelihood of amputations from 9% to zero, preserving patients' mobility and independence.
Enhanced Healing Rates and Reduced Healing Duration: Through DLS's surgical interventions, advanced wound care, and optimized diabetes management, we have achieved an impressive 40% increase in the healing rate of diabetic foot ulcers, along with a 30% reduction in treatment duration for patients receiving DLS treatment. This not only promotes swifter recovery but also significantly lowers the risk of infection.
Reduced recurrences: Diabetic foot ulcers are a problem that often recur. DLS has shown a 76% reduction in recurring ulcers among patients, which has improved their quality of life.
Mr Muhammad Sufian bin Rahim, 33 years old, was a beneficiary under this care model. He lost a toe as well as his job as a result of his diabetes. “I was able to walk a month after my surgery. I am now able to wear normal shoes again and have since started on a new job. I am grateful for the holistic treatment and recovery care plan to restore my mobility and livelihood.” Said Muhammad of his patient experience at SKH.
Mdm Zuriah bte Rasman, 40 years old, underwent amputation of a toe with wound soft tissue reconstruction in March 2021. She remarked “I was fearful of losing my foot as I was then the sole
breadwinner of the family with two school going children. I am very thankful for the one-stop integrated care at SKH that enabled me to walk again with special shoes. Three months after the surgery, I was able to return to work to continue to provide for my family once more.”
Assistant Professor Francis Wong, Consultant, Orthopaedic Surgery, SKH shared, “In SKH, we see many younger patients with diabetic foot problems who are sole breadwinners for their families. Should they undergo a limb amputation, their family’s livelihood will be impacted. By incorporating plastic surgery expertise into our DLS service, we are able to improve patient outcomes. We are dedicated to not only saving limbs but also ensuring that patients can regain their mobility and independence. It is one of many initiatives that SKH is undertaking to ensure that patients diagnosed with diabetes can continue to live as normal a life as possible.”
About Sengkang General Hospital
Sengkang General Hospital (SKH) forms a vital part of Singapore's master plan to provide quality and accessible care to better serve the healthcare needs in North-Eastern Singapore. Offering a wide spectrum of specialist clinics and co-located with Sengkang Community Hospital, we are a part of the integrated hospital campus delivering multi-disciplinary and patient-centric care covering all major healthcare disciplines.
Reflecting on our mission of achieving better health together, SKH's team of doctors, nurses, and allied health professionals practise multi-disciplinary and team-based care. Patients who need longer-term rehabilitative care can be seamlessly transferred from the general hospital to the community hospital to receive the appropriate care during their recovery. We also work together with polyclinics, general practitioners, and other healthcare providers to ensure timely and appropriate access to specialist care for acute and complex cases.
Enabling residents in the northeast access to national speciality services nearer their homes, SKH has collaborated with KK Women’s and Children’s Hospital, National Cancer Centre Singapore, National Dental Centre Singapore, National Heart Centre Singapore, and Singapore National Eye Centre, to set up satellite clinics within the hospital’s Medical Centre. For more information, visit https://www.skh.com.sg/.
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- MOH. Diabetes: The war continues. 2017. https://www.moh.gov.sg/content/moh_web/home/pressRoom/pressRoomItemRelease/2017/diabetes--the-war-continues. Accessed 31 May 2018.
- Armstrong DG, Boulton AJM, Bus SA. Diabetic Foot Ulcers and Their Recurrence. N Engl J Med. 2017 Jun 15;376(24):2367-2375. [PubMed]
- Thng CB, Wong KL, Wong A, Chew KY, Leow K, Alvis LTC, Leong S, Irani FG, Png WX, Cher EWL, Ma ZZ, Mardiana BM, Wong MK, Tan WWP, Kok YO, Feng J. (2023). Early results of Orthoplastic multidisciplinary approach focused on diabetic foot ulcer soft tissue reconstruction demonstrates improved healing, reduced major amputation rate, and reduced recurrence. Journal of Wound Care.
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