The Diabetic Limb Salvage service at Sengkang General Hospital is provided by a multidisciplinary team that enhances patient outcomes and prevents lower limb amputations caused by diabetes.

When Dr Francis Wong, Consultant, Department of Orthopaedic Surgery, Sengkang General Hospital (SKH) joined the hospital in 2018, he was struck by how many patients, some as young as those in their 30s, were afflicted with diabetes and diabetic foot problems.

“Often, patients with diabetic infections do not realise they have diabetes or how the infections occurred. Poorly controlled diabetes is a major contributor of diabetic foot problems,” said Dr Wong.

For patients with diabetes, a foot ulcer or infection can be severe. High blood sugar levels impair the body’s ability to fight infections. Poorly controlled diabetes damages nerves in the legs and feet, which prevents the patient from feeling pain and realising that an injury has occurred. Oral antibiotics treatment also becomes ineffective, as glucose in the blood hinders its flow to the small capillary blood vessels in the foot.

In serious cases, patients may need to go through an amputation. “In SKH, we see many younger patients who are sole breadwinners for their families. Should they undergo an amputation, their family’s livelihood will be affected,” Dr Wong said.

“Of the patients who lose their leg, only half of them regain the ability to walk; the remainder are confined to wheelchairs or require long-term care at a nursing home,” he added.

Diabetic Limb Salvage clinic

To tackle this issue, Dr Wong brought together healthcare professionals to form a multidisciplinary team, which comprises podiatrists, nurses and orthopaedic surgeons, in 2019.

The new approach allows the same care team to journey with the patient — from inpatient admission to outpatient clinic follow-ups and final discharge. This is made possible by combined ward rounds, outpatient clinics and day surgeries, giving patients confidence as the same team is seeing them through their treatment journey from start to end. This approach has shown promising results. Patients’ recovery time was halved, from six to three months.

Meanwhile, more colleagues from other disciplines learnt about this initiative. By 2020, the plastic surgeons at SKH had volunteered to join the team, followed by the interventional radiologists. In 2021, the newly expanded team cared for more than 50 patients with complex diabetic foot problems, most of whom were on the verge of losing their limbs, and recovery time was reduced even further.

Most importantly, none of these patients had to lose a limb. The unique multidisciplinary approach of the Diabetic Limb Salvage (DLS) team was effective in preventing major amputations, and many patients were able to return to work in two months.

“By having the different specialists see the same patient in one setting, it shows that we mean it when we say, ‘We are here for you’. Not just one doctor, but everyone in the team is here for you. For the patient, it is also a morale booster and they need not shuttle between different appointments to see their doctors. We are seeing good results and believe this is the way forward to care for our patients,” Dr Wong said.

With the added expertise of infectious disease specialists and dietitians, as well as increasing referrals from other disciplines at SKH, the initiative has been formalised into the DLS service and is open for referrals by all polyclinics.

The myriad expertise of the DLS team, which now includes orthopaedic surgeons, plastic surgeons, infectious disease specialists, podiatrists, wound care nurses, dietitians and interventional radiologists, adds up to a formidable array of specialised skills to enhance patient outcomes. Patients are tended to by the same team in both the outpatient clinics and inpatient wards.

For more information, watch an exclusive interview with Dr Francis Wong here:

Preventing diabetes

Regular age-appropriate exercise, a balanced diet and managing blood sugar levels are key to preventing diabetes. Patients with diabetes should adhere to yearly screening. For high-risk patients who have had foot ulcers or leg wounds, the screening should be done every three to six months.

Foot care

Here are some tips to care for your feet:

Avoid going barefoot to reduce the risk of injury or cuts.

If your job requires you to wear specific footwear such as safety shoes, make sure you change into comfortable shoes when the work is done.

Moisturise your feet often, do regular self-checks, and look out for cracks and calluses.

Practise proper ways of cutting toenails to prevent bleeding, which can lead to infections.

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