Outcomes of primary vs staged wound closure for major lower limb amputations in diabetic patients: A propensity score matched study

Objective: To compare perioperative outcomes including wound complications, length of hospital stays and mortality in diabetic foot patients undergoing major lower limb amputation (MLLA) with primary wound closure vs staged wound closure. Methodology: This retrospective cohort study included 111 diabetic patients who underwent MLLA at a tertiary care centre in Pakistan between 1^st January 2018 and 31^st December 2023. A 1:5 propensity score matching (PSM) approach was used to balance patient characteristics, resulting in a matched cohort of 66 patients (55 in the primary closure group, 12 in the staged closure group). The primary outcome was the rate of local wound complications, and secondary outcomes included length of hospital stay and mortality. Categorical data were compared using Fisher’s exact test, and continuous data were analysed using Mann-Whitney U tests, with a significance threshold of p < 0.05. Results: Primary wound closure (Group-I) resulted in significantly fewer wound complications (1.8%) compared to staged closure (Group-II) (36.4%) (p = 0.002). Secondary outcomes showed a significantly longer hospital stay in the staged closure group (8.9 days vs. 6.6 days, p < 0.05). There was no significant difference in mortality between the two groups. Conclusion: Primary wound closure during MLLA is associated with superior wound outcomes and reduced hospitalization compared to staged amputation with secondary wound closure. These findings support the use of primary closure as the preferred approach in resource-limited settings.