Prevalence of Ischemia in Diabetic Foot Infection

Abstract

Foot infection is a common problem affecting diabetics. In addition to neuropathy, ischemia is a major factor contributing to the progress and morbidity of the disease. The aim of this study was to determine the prevalence of lower limb ischemia in patients with diabetic foot infection prospectively measuring the ankle-brachial pressure index (ABI). Over a 21-month period 60 patients were treated in the general surgical ward of Princess Basma Teaching Hospital. Ischemia was present in 35 of the 60 patients (58.4%). Among them 27 had moderate ischemia (ABI 0.5-0.9) and were treated successfully before further vascular workup. The other 8 patients had severe ischemia (ABI < 0.5) and required below-knee amputation because their feet were severely infected and not salvageable. This study confirmed the recommendation for early detection of lowerlimb ischemia in diabetics, especially those with foot infection, as it should improve the outcome of treatment. In addition to patient education and periodic foot examinations, estimating the ABI is an easy, reliable way to determine foot blood flow and to detect patients who require further vascular workup and treatment.

Diagnosis and Treatment of Diabetic Foot Infections

“…Elective amputation may be considered for the patient who has recurrent ulceration (despite maximal preventive measures), has irreversible loss of foot function, or would require unacceptably prolonged or intensive hospital care [181,182]. Selection of the level of amputation must take into consideration vascular, reconstructive, and rehabilitation issues [183,184]. Generally, the surgeon should attempt to save as much of the limb as possible.…”

Systematic review of methodologies used to assess mastectomy flap viability

“…As inadequate skin flap perfusion may contribute to other seemingly unrelated complications, such as delayed wound healing and infection22, consistent and systematic reporting of infection, seroma and delayed wound healing should be carried out, along with the severity of reoperation undertaken as a result of skin flap necrosis (such as simple debridement, readjustment of reconstruction or implant removal). To facilitate cost analysis, there should be reporting of prolonged hospital stay, duration of prolonged wound care owing to complications, and prolonged time to completion of breast reconstruction resulting from mastectomy flap necrosis.…”

“…Planned oncological therapies may be delayed and the patient's quality of life affected10. Inadequate perfusion can also contribute to more generic complications such as delayed wound healing and infection22. Finding a means of objectively assessing mastectomy flap perfusion accurately and cost‐effectively is desirable.…”

The Diabetic Foot

“…Osteomyelitis may be optimally defined by bone culture and histology [9, 25,26]. A Duplex ultrasound scan (USS) would assess blood flow to the foot [1,4,14].…”

“…Its causes are incompletely understood, but it is clear that the disease is often multifactorial and that both genetic and environmental factors are involved [2]. Approximately 90% of diabetics have type 2 diabetes (non-insulin dependent -NIDDM) and most complications of diabetes are related to vascular impairment [1][2][3][4]. Diabetics are at increased risk of developing infections, peripheral neuropathy, retinopathy and renal impairment or failure.…”