Study of various reconstructive modalities in management of diabetic foots
DOI:
https://doi.org/10.18203/2320-6012.ijrms20242945Keywords:
Diabetic foot, Foot reconstructive surgery, Diabetic foot complications, Skin graft, Local flaps, Free flapsAbstract
Diabetic foot ulceration is the most common complication seen in the patient with diabetes with lifetime risk of a foot ulcer as high as 25%, which is the most critical risk factor for lower-extremity amputation. In this study, we have reviewed our experiences with diabetic foot and established an algorithm for surgical reconstruction of diabetic foot. We studied 50 patients and clinical findings based on predisposing factors, complications, treatment and sequalae were studied, analysed and discussed. Split thickness skin graft, local or distant flap surgery was planned according to patient factors. The best possible option was chosen to cover the defect. Patient was monitored in post- operative period for any signs of flap failure and appropriate measures were taken, if required to treat such complications. Out of 50 cases studied, 29 (58%) patients were managed with split thickness skin graft. 14 (28%) patients were managed with flap surgery. Various post operative complications were managed accordingly. The choice of reconstructive modality in the management of diabetic foot ulcers should be based on the specific characteristics of the wound and the patient's overall condition. Skin grafts are suitable for larger wounds over dorsum of foot and wounds over non weight bearing area of sole, while flaps provide stable, supple, durable and sensate coverage. To prevent recurrence, well-padded flap with sensate coverage is needed. Ultimately, the selection of the appropriate reconstructive modality should be made to ensure the best possible outcome for the patients.
References
Boulton AJ. The diabetic foot. Surg Int. 1995;37:6.
Boulton AJ, Armstrong DG, Albert SF. Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American diabetes association, with endorsement by the American association of clinical endocrinologists. Diabetes Care. 2008;31:1679-85.
Margolis DJ, Allen-Taylor L, Hoffstad O. Diabetic neuropathic foot ulcers and amputation. Wound Repair Regen 2005;13:230-6.
Muha J. Local wound care in diabetic foot complications. Aggressive risk management and ulcer treatment to avoid amputation. Postgrad Med. 1999;106:97-102.
Pinzur MS, Slovenkai MP, Trepman E. Guidelines for diabetic foot care: recommendations endorsed by the Diabetes committee of the American orthopaedic foot and ankle society. Foot Ankle Int. 2005;26:113-9.
Edmonds M. Diabetic foot ulcers: practical treatment recommendations. Drugs 2006;66:913-9.
Bello YM, Phillips TJ. Recent advances in wound healing. JAMA 2000;283:716-8.
Caballero E, Frykberg RG. Diabetic foot infections. J Foot Ankle Surg. 1998;37:248-55.
Tan JS, Friedman NM, Hazelton-Miller C. Can aggressive treatment of diabetic foot infections reduce the need for above-ankle amputation? Clin Infect Dis. 1996;23:286-91.
Diamantopoulos EJ, Haritos D, Yfandi G. Management and outcome of severe diabetic foot infections. Exp Clin Endocrin Diab. 1998;106:346-52.
Caputo GM, Cavanagh PR, Ulbrecht JS. Assessment and management of foot disease in patients with diabetes. N Engl J Med. 1994;331:854-60.
Bochicchio GV, Sung J, Bochicchio K. Persistent hyperglycaemia is predictive of outcome in critically ill trauma patients. J Trauma. 2005;58:921-4.
Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997;38:563-76.
Frykberg RG. Diabetic foot infections: evaluation and management. Adv Wound Care 1998;11:329-31.
Tan JS, Friedman NM, Hazelton-Miller C. Can aggressive treatment of diabetic foot infections reduce the need for above-ankle amputation? Clin Infect Dis. 1996;23:286-91.
Diamantopoulos EJ, Haritos D, Yfandi G. Management, and outcome of severe diabetic foot infections. Exp Clin Endocrinol Diab. 1998;106:346-52.
Mayfield, Jennifer A. "A foot risk classification system to predict diabetic amputation in Pima Indians". Diabetes care. 1996:704-9.
Bell ET. Atherosclerotic gangrene of the lower extremities in diabetic and non-diabetic. Am J Clin Pathol. 1957;28(1):27-36.
Sridharan K, Sivaramakrishnan G. Growth factors for diabetic foot ulcers: mixed treatment comparison analysis of randomized clinical trials. Br J Clin Pharmacol. 2018;84(3):434-44.
Apelqvist J, Larsson J, Agard C. Long term prognosis for diabetic patients with foot ulcers. J Int Med. 1993;233:485-91.
Reiber GE, Lipsky BA, Gibbons GW. The burden of diabetic foot ulcers. Am J Surg 1998;176:5-10.
Grams. Diabetic neuropathies. Am J Surg. 1969;4:401-25.
Beidelman and Duncan GG. AIM. 1969;12:43.
Grayson ML, Gibbons GW, Habershaw GM. Use of ampicillin/sulbactam versus imipenem/cilastatin in the treatment of limb-threatening foot infections in diabetic patients. Clin Infect Dis. 1994;18:683-93.
Yeh TJ, Lin, Hung C, Lin Yu-Te. Skin grafting as a salvage procedure in diabetic foot reconstruction to avoid major limb amputation. Chang Gung Med J. 2010;33:389-96.
Ramanujam CL, Zgonis T. The Diabetic Charcot Foot from 1936 to 2016: Eighty Years Later and Still Growing. Clin Podiatr Med Surg. 2017;34(1):1-8.
