{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:10:23Z","timestamp":1790835023985,"version":"4.1.0"},"reference-count":36,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2021,12,30]],"date-time":"2021-12-30T00:00:00Z","timestamp":1640822400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot &amp; Ankle Specialist"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Several risk factors for lower extremity amputation in diabetic patients have been identified; however, late presentation has been poorly investigated. Very few studies looked at the impact of such risk factor. As none has investigated the link between admission to amputation and late presentation in this population, we investigated such association.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study is a retrospective comparative cohort of continuous series of patients admitted for amputation related to diabetic foot ulcer (DFU) as a first treatment. A late presentation was defined as a period of 3 weeks or more from the onset of the ulcer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Forty-six patients admitted for amputation and all wounds were infected and located on the plantar forefoot in 32 cases (69.5%), on the toes in 10 cases (21.7%), and in the heel area in 4 cases (8.8%). The mean duration to admission was 5.2 \u00b11.8 weeks (range 4-10 weeks). Late presentation was recorded in 42 (91.3%) patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study demonstrates that amputation due to DFU is highly associated with late presentation. Educational campaigns targeting patient and first-line health care providers and highlighting the urgency of diabetic ulcers are needed to impact this major modifiable risk factor.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Levels of Evidence<\/jats:title>\n                    <jats:p>Therapeutic, Level III: Retrospective Comparative<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19386400211067625","type":"journal-article","created":{"date-parts":[[2021,12,30]],"date-time":"2021-12-30T05:25:26Z","timestamp":1640841926000},"page":"474-478","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Amputation as a First Treatment is Highly Associated With Late Presentation: An Underestimated Modifiable Major Risk Factor for Diabetic Foot Ulcer"],"prefix":"10.1177","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0094-9892","authenticated-orcid":false,"given":"Kaissar","family":"Yammine","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, LAU Medical Center-Rizk Hospital, School of Medicine, Lebanese American University, Beirut, Lebanon (KY, CA)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Akiki","sequence":"additional","affiliation":[{"name":"Diabetic Foot Clinic, LAU Medical Center-Rizk Hospital, Lebanese American University, Beirut, Lebanon (KY)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chahine","family":"Assi","sequence":"additional","affiliation":[{"name":"Center for Evidence-Based Anatomy, Sport & Orthopedics Research (KY, CA)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fady","family":"Hayek, MD","sequence":"additional","affiliation":[{"name":"Department of Clinical Nutrition, LAU Medical Center-Rizk Hospital, School of Medicine, Lebanese American University, Beirut, Lebanon (SA); and Division of Vascular Surgery, Department of Surgery, LAU Medical Center-Rizk Hospital, School of Medicine, Lebanese American University, Beirut, Lebanon (FH)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,12,30]]},"reference":[{"key":"bibr1-19386400211067625","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2006.12.006"},{"key":"bibr2-19386400211067625","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-008-0940-0"},{"key":"bibr3-19386400211067625","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.16.1.16"},{"key":"bibr4-19386400211067625","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpm.2007.03.007"},{"key":"bibr5-19386400211067625","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.848"},{"key":"bibr6-19386400211067625","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2016.01.012"},{"key":"bibr7-19386400211067625","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2020.07.086"},{"key":"bibr8-19386400211067625","doi-asserted-by":"publisher","DOI":"10.7547\/0980489"},{"key":"bibr9-19386400211067625","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djx030"},{"key":"bibr10-19386400211067625","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12404"},{"key":"bibr11-19386400211067625","doi-asserted-by":"publisher","DOI":"10.1007\/s11892-019-1125-6"},{"key":"bibr12-19386400211067625","doi-asserted-by":"publisher","DOI":"10.4239\/wjd.v7.i8.165"},{"key":"bibr13-19386400211067625","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/902873"},{"key":"bibr14-19386400211067625","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2017.26.Sup9.S27"},{"key":"bibr15-19386400211067625","doi-asserted-by":"publisher","DOI":"10.18295\/squmj.2018.18.03.012"},{"issue":"2","key":"bibr16-19386400211067625","first-page":"147","volume":"27","author":"Al-Wahbi AM.","year":"2006","journal-title":"Saudi Med J"},{"issue":"2","key":"bibr17-19386400211067625","first-page":"151","volume":"5","author":"Alzahrani HA.","year":"2012","journal-title":"Ann Vasc Dis"},{"key":"bibr18-19386400211067625","doi-asserted-by":"publisher","DOI":"10.2147\/DMSO.S171526"},{"key":"bibr19-19386400211067625","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0239236"},{"key":"bibr20-19386400211067625","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)13169-8"},{"key":"bibr21-19386400211067625","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2018.27.3.186"},{"key":"bibr22-19386400211067625","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2019.28.Sup8.S4"},{"key":"bibr23-19386400211067625","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2018.27.5.310"},{"key":"bibr24-19386400211067625","doi-asserted-by":"publisher","DOI":"10.3402\/dfa.v6.29629"},{"key":"bibr25-19386400211067625","doi-asserted-by":"publisher","DOI":"10.2337\/dc07-2244"},{"key":"bibr26-19386400211067625","doi-asserted-by":"publisher","DOI":"10.1080\/2000625X.2017.1367210"},{"key":"bibr27-19386400211067625","first-page":"8931508","volume":"2016","author":"Quilici MT","year":"2016","journal-title":"J Diabetes Res"},{"key":"bibr28-19386400211067625","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2015.11.025"},{"key":"bibr29-19386400211067625","volume-title":"Levin and O Neal\u2019s the Diabetic Foot","volume":"6","author":"Boulton AJ","year":"2001","edition":"6"},{"issue":"4","key":"bibr30-19386400211067625","first-page":"286","volume":"4","author":"Armstrong DG","year":"2007","journal-title":"IWJ"},{"key":"bibr31-19386400211067625","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1615439"},{"key":"bibr32-19386400211067625","unstructured":"National Institutes of Health (NIH). Take care of your feet for a lifetime. A Booklet for People with Diabetes. National Diabetes Education Program. Rockville, MD: National Institutes of Health; 2014. 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