Optimal Treatment of Infected Diabetic Foot Ulcers

Abstract

Foot ulceration can lead to devastating consequences in diabetic patients. They are not only associated with increased morbidity but also mortality. Foot infections result as a consequence of foot ulceration, which can occasionally lead to deep tissue infections and osteomyelitis; both of which can result in loss of limb. To prevent amputations prompt diagnosis and treatment is required. Understanding the pathology of the diabetic foot will help in the planning of appropriate investigations and treatment. Clinical diagnosis of infection is based on the presence of discharge from the ulcer, cellulitis, warmth and signs of toxicity; though the latter is uncommon. Deep tissue samples from the ulcer and/or blood cultures should be taken before, but without delaying the start of antibacterial treatment in limb and life-threatening infections. In milder infections wound sampling may direct appropriate antibacterial treatment. Staphylococcus aureus, followed by streptococci are the most common organisms causing infection and antibacterial treatment should be targeted against these organisms in mild infection possibly with monotherapy. But in serious infections combination therapy is required because these are usually caused by multiple organisms including anaerobes. Drug-resistant organisms are becoming more prevalent and methicillin-resistant infections can be treated effectively with a number of oral antibacterials either as monotherapy or in combination. Surgical treatment with debridement, for example, callus removal or drainage of pus form an important part of diabetic foot ulcer management especially in the presence of infection. Occasionally limited surgery including dead infected bone removal may be necessary for resolution of infection. Amputation is sometimes required as a last resort for limb or life preservation.

Temporal Trends and Geographic Variation of Lower-Extremity Amputation in Patients With Peripheral Artery Disease

“…(9,10) Second, studies of revascularization procedures in PAD patients have consistently shown that the use of endovascular revascularization has increased significantly after 2000 and when combined with improved screening and detection methods may contribute to the decline in amputation rates. (11) In the current study, we used the Part A Medicare dataset that captured inpatient billing claims, and due to this, we were unable to fully explore the use of screening tests and revascularization procedures, some of which may be performed more frequently on an outpatient basis. Despite the national shift to outpatient care and procedures in cardiovascular medicine, it is unlikely to affect the measurement of major LE amputations such as above and below knee amputations, but could be possible for ray amputations.…”

Effect of percutaneous transluminal angioplasty on tissue oxygenation in ischemic diabetic feet

“…Adequate tissue oxygenation is an essential factor in diabetic foot management 1 . Bypass graft surgery and percutaneous transluminal angioplasty (PTA) are generally recommended to improve tissue oxygenation of ischemic diabetic feet.…”

The effect of the glycolipoprotein extract (G‐90) from earthworm Eisenia foetida on the wound healing process in alloxan‐induced diabetic rats

“…One of the problems in patients with diabetes is the wound in the lower limbs, especially the feet. Almost 25% of people suffering from diabetes during their life time . Because the treatment for these wounds is time‐consuming, expensive and often does not lead to a good outcome, the medical community and researchers are constantly looking for new ways to treat these conditions.…”