The Diabetic Foot Attack: “’Tis Too Late to Retreat!”

Abstract

The "diabetic foot attack" is one of the most devastating presentations of diabetic foot disease, typically presenting as an acutely inflamed foot with rapidly progressive skin and tissue necrosis, at times associated with significant systemic symptoms. Without intervention, it may escalate over hours to limb-threatening proportions and poses a high amputation risk. There are only best practice approaches but no international protocols to guide management. Immediate recognition of a typical infected diabetic foot attack, predominated by severe infection, with prompt surgical intervention to debride all infected tissue alongside broad-spectrum antibiotic therapy is vital to ensure both limb and patient survival. Postoperative access to multidisciplinary and advanced wound care therapies is also necessary. More subtle forms exist: these include the ischemic diabetic foot attack and, possibly, in a contemporary categorization, acute Charcot neuroarthropathy. To emphasize the importance of timely action especially in the infected and ischemic diabetic foot attack, we revisit the concept of "time is tissue" and draw parallels with advances in acute myocardial infarction and stroke care. At the moment, international protocols to guide management of severe diabetic foot presentations do not specifically use the term. However, we believe that it may help increase awareness of the urgent actions required in some situations.

Infectious aspects of the Diabetic Foot Syndrome

“…Az amputációra azonban leggyakrabban a diabéteszes láb akut szövődményeinek kapcsán kerül sor. A diabéteszes láb krízisállapotának súlyát hangsúlyozza "diabetic foot attack" (4). Ez a súlyos, akár életet is veszélyeztető állapot a többi akut (kardiovaszkuláris) szövődményhez (szí-vinfarktus, stroke) hasonló szervezettségű sürgősségi kezelést igényel (5,6).…”

Surgery for the diabetic foot: A key component of care

“…to control the progression of infection. As the name implies, these procedures are performed emergently and usually consist of open amputations at the foot level with attendant fasciotomies of the leg …”

“…These can potentially be limb threatening without timely intervention as delay will lead to further tissue loss. The concept of ‘time is tissue’ is applicable to such infection, which is labelled as a ‘Diabetic Foot Attack’ …”

“…The concept of 'time is tissue' is applicable to such infection, which is labelled as a 'Diabetic Foot Attack'. 23 The management of diabetic foot attack is best delivered in a multidisciplinary setting using a structured approach. The management principles are as follows: should aim to achieve complete healing of the wound in a timely manner and various methods can be used to achieve this; including negative pressure wound therapy (NPWT), followed by skin grafting or a similar form of plastic surgical procedure, depending on the extent of the wound and its location.…”

Editorial and Mini-Review: Topical Oxygen Therapy for Diabetic Foot Ulcerations - Avenue Towards New Hope?

“…We also need to know more on both the optimal selection of patients and the window of therapeutic opportunity. Meanwhile, prompt recognition, early specialist referral, and intensive multidisciplinary management of DFUs remain crucial [21].…”