The appropriate management algorithm for diabetic foot

Abstract

Background:Diabetic foot management is a challenge for reconstructive surgeons because it combines dramatically decreased circulation and chronic infection. The goal of managing this condition is to maximize viable tissue; however, unsatisfactory results, such as extremity amputation, are unavoidable in some cases. For appropriate management, thorough understanding of diabetic foot and the phased approach to its management is needed. The purpose of this study is to introduce an optimal algorithm for diabetic foot management by analyzing cases >12 years.Methods:A total of 274 patients with diabetic foot at Hanyang University Guri Hospital from 2005 to 2017 were reviewed. The management process was divided into 5 steps: patient evaluation, wound preparation, improving vascularity, surgery and dressing, and rehabilitation. Patient evaluation included a microbial culture, evaluation of vascularity, and an osteomyelitis assessment. During wound preparation, debridement and negative-pressure wound therapy were performed. Vascularity was improved by radiological intervention or surgical method. Surgery and dressing were performed depending on the indications. Rehabilitation was started after complete wound healing.Results:An infection was confirmed in 213 of 263 patients (81.0%). Of 74 cases in which a vascular study was performed, 83.8% showed arterial occlusion. When surgery was performed with complete eradication of the infection in 155 patients, the rate of revision surgery was 20.6%. The revision rate after surgery with a remnant infection of 66 patients was 40.9% (P = .0003). When surgery was performed after successful revascularization for improving blood flow of 47 patients, the rate of revision surgery was 21.3%. In contrast, the revision rate after surgery with unsuccessful or no revascularization of 174 patients was 28.2% (P = .359).Conclusion:Diabetic foot is a debilitating disease arising from multifactorial process. As its management is complex, a comprehensive but accessible treatment algorithm is needed for successful results. For this reason, the appropriate algorithm for diabetic foot management introduced in this study is significant.

Clinical, Pathological and Microbiological Evaluation of Diabetic Foot Syndrome

“…The Wagner-Meggitt classification is used for grading DFUs in many settings. According to this classification, patients that were included in this research—most of them in stage II, III and IV—had almost the same results from other studies, meaning lesions from deep ulcers to tendon, bone or capsule to deep ulcers with bone involving the abscess and gangrene of toes or forefeet [ 12 , 34 , 35 ]. Evidence of infection was seen in the majority of patients, and many DFUs are polymicrobial.…”

Challenges of dealing diabetic foot and step wise surgical management

“…Cheng, Xuyen shows in another article about patients consisted of 168 males and 106 females where n = 274. 26 Among 34 patients 14 patients require early surgery and managed to send home within 7 days but 8 individuals with primary care setting foot ulceration managed with Vacuum Assisted Closure along with graft and Surgery. One Patient managed with VAC therapy along with surgery required to stay 16 days at hospital.…”

“…A large number of patients also managed by skin graft. 11.4% patients wound covered but skin graft and 6.4% patients required skin graft along with Acellular dermal matrix 26.…”

Diabetic foot and peripheral arterial disease

“… 29 This would put an excessive pressure on the health system and economy, due to the large number of diabetic patients in KSA, which means a comprehensive but attainable treatment algorithm is needed to get successful results. 30 , 31 …”