A Stepwise Approach for Surgical Management of Diabetic Foot Infections

Fisher, Timothy K.; Scimeca, Christy L.; Bharara, Manish; Mills, Joseph L.; Armstrong, David G.

doi:10.7547/1000401

Cited by 18 publications

(10 citation statements)

References 20 publications

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“…64 In particular, patients with a foot infection are at high risk for limb loss and should be treated as a medical emergency. The 1-year major amputation rate for such patients has been reported to be as high as 44%, 65 and delay in treatment can lead to rapid tissue destruction and lifethreatening sepsis 66 In those patients in whom the risk-benefit ratio of revascularization is unclear, it should be taken into account that some severely ischaemic ulcers heal without revascularization-two observational studies demonstrated healing rates of around 50% (with or without minor amputations) in patients unsuitable (either because they were deemed too frail or where revascularization was not technically possible) for revascularization. 10 There are several other techniques that have been investigated for patients with diabetes, PAD, and ulceration in whom there are no options for revascularization.…”

Section: Rationalementioning

confidence: 99%

Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update)

Hinchliffe

Forsythe

Apelqvist

et al. 2020

Diabetes Metabolism Res

269

262

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The International Working Group on the Diabetic Foot (IWGDF) has published evidence‐based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the diagnosis, prognosis, and management of peripheral artery disease (PAD) in patients with foot ulcers and diabetes and updates the previous IWGDF Guideline. Up to 50% of patients with diabetes and foot ulceration have concurrent PAD, which confers a significantly elevated risk of adverse limb events and cardiovascular disease. We know that the diagnosis, prognosis, and treatment of these patients are markedly different to patients with diabetes who do not have PAD and yet there are few good quality studies addressing this important subset of patients. We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to devise clinical questions and critically important outcomes in the patient‐intervention‐comparison‐outcome (PICO) format, to conduct a systematic review of the medical‐scientific literature, and to write recommendations and their rationale. The recommendations are based on the quality of evidence found in the systematic review, expert opinion where evidence was not available, and a weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to the intervention. We here present the updated 2019 guidelines on diagnosis, prognosis, and management of PAD in patients with a foot ulcer and diabetes, and we suggest some key future topics of particular research interest.

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Section: Rationalementioning

confidence: 99%

Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update)

Hinchliffe

Forsythe

Apelqvist

et al. 2020

Diabetes Metabolism Res

269

262

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“…DFI is the leading cause of non-traumatic lower limb amputations. [4][5][6][7] The main aim was to study the DFI which is responsible for increased morbidity, amputations and even mortality in diabetic patients. [8][9][10] Diabetic foot infections were more common (33.33%) in age group of 45-54 years whereas P.C Leung reported 75% infections occurred above the age of 50 years.…”

Section: Discussionmentioning

confidence: 99%

Diabetic foot infections and management: A Rural Indian Perspective

Mote¹,

Mote²

2015

Int Jour of Biomed Res

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Aim and objective: This study was carried out to study demographic features of patients suffering from diabetic foot infections and also to know microorganism causing infections and its management. Study design: It is a hospital based cohort study. Place and duration of study: Department of General Surgery, K.I.M.S, Andhra Pradesh, from Jan 2007 to December 2009. Material and methods: The study was conducted at tertiary care teaching hospital in Andhra Pradesh from 2007 to 2009. The patients of both gender and all age groups who presented with diabetic foot infections comprised the study. The history of diabetic foot was obtained and thorough clinical examination was carried out after written informed consent from patient. The Subject underwent routine and specialized investigations like swab for culture and sensitivity, radiographs of foot. The patients were managed with insulin or oral anti diabetic agents, debridement, drainage, skin grafting. The severe infection cases required amputations to save life of patients. All patients followed until discharge or death. Results: Out of 60 cases 40 were male and 20 female patients. Diabetic foot ulcers were more common in age group of 45-54 (33.33%).Diabetic foot infections were observed more in patients having diabetes for duration of more than years (75.00%). More than 60 % of cases were in Wagner's grade III to V. Most common organisms responsible for diabetic foot infection were gram positive organisms, 43.33% of cases whereas 16.67% had poly microbial infection.The present study revealed that ceftriaxone was found to be effective in 33.33% of cases of infections followed by amikacin in 25% of cases . Amputations were done in 43.33% cases due to severe life threating spreading, uncontrolled infections. Conclusion: As the diabetic mellitus cases are increasing globally, it is becoming the public health problem. There is huge burden on economy, health system and on society. It is affecting the quality of life of citizens which requires orchestrated efforts from all stake holders to prevent and minimise the foot infections and reduce the number of amputations.

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“…A limb preservation team must be able to perform bedside and intraoperative incision and debridement to decompress limb-threatening abscesses and debride nonviable tissue. Surgeons involved in this care should have knowledge and interest in this aspect of limb preservation (25). If insufficient blood flow to the extremities impairs delivery of antibiotics or oxygen, revascularization should be done as soon as the major infection has been adequately addressed.…”

Section: Surgical Management Of Infectionsmentioning

confidence: 99%

Inpatient Management of Diabetic Foot Disorders: A Clinical Guide

et al. 2013

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The implementation of an inpatient diabetic foot service should be the goal of all institutions that care for patients with diabetes. The objectives of this team are to prevent problems in patients while hospitalized, provide curative measures for patients admitted with diabetic foot disorders, and optimize the transition from inpatient to outpatient care. Essential skills that are required for an inpatient team include the ability to stage a foot wound, assess for peripheral vascular disease, neuropathy, wound infection, and the need for debridement; appropriately culture a wound and select antibiotic therapy; provide, directly or indirectly, for optimal metabolic control; and implement effective discharge planning to prevent a recurrence. Diabetic foot ulcers may be present in patients who are admitted for nonfoot problems, and these ulcers should be evaluated by the diabetic foot team during the hospitalization. Pathways should be in place for urgent or emergent treatment of diabetic foot infections and neuropathic fractures/dislocations. Surgeons involved with these patients should have knowledge and interest in limb preservation techniques. Prevention of iatrogenic foot complications, such as pressure sores of the heel, should be a priority in patients with diabetes who are admitted for any reason: all hospitalized diabetic patients require a clinical foot exam on admission to identify risk factors such as loss of sensation or ischemia. Appropriate posthospitalization monitoring to reduce the risk of reulceration and infection should be available, which should include optimal glycemic control and correction of any fluid and electrolyte disturbances.

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A Stepwise Approach for Surgical Management of Diabetic Foot Infections

Cited by 18 publications

References 20 publications

Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update)

Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update)

Diabetic foot infections and management: A Rural Indian Perspective

Inpatient Management of Diabetic Foot Disorders: A Clinical Guide

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