A Stepwise Approach to the Surgical Management of Severe Diabetic Foot Infections

Abstract

Foot infections are common among diabetic patients with ulceration and are a major cause of hospitalization and lower extremity amputation. Aggressive and emergent surgical intervention is essential in the face of life- or limb-threatening infection to achieve limb salvage and survival. Critical limb ischemia, neuropathy, and an impaired host complicate the treatment of a severe diabetic foot infection. A severe diabetic foot infection carries a 25% risk of major amputation. For this reason, surgery should be coordinated with a well-functioning multidisciplinary team that specializes in diabetic limb preservation. Timing of surgery and strategies employed should be understood and agreed on by both the surgical and medical disciplines managing the diabetic patient with a limb-threatening infection. The overall strategy for surgically managing a severe diabetic foot infection is as follows: the first step is infection control through aggressive and extensive surgical debridement, the second step is a comprehensive vascular assessment with possible vascular surgery and/or endovascular intervention, and the final step is soft tissue and skeletal reconstruction after infection is eradicated to obtain wound closure and limb salvage. A consistent stepwise surgical approach combined with sound surgical principles is paramount for successful management of the severe diabetic foot infection. The authors discuss their stepwise surgical approach to reduce the mortality, morbidity, psychological distress, and length of hospitalization associated with life- or limb-threatening diabetic foot infections.

Antibiotic therapy for diabetic foot infections in a tertiary care hospital in Jakarta, Indonesia

“…Various studies show that diabetic foot infection has the longest hospital stay as compared to other complications of diabetes [11,12]. We found that the most of the diabetic foot patients were hospitalized for about 2 weeks.…”

“…This diabetic complication is very difficult to treat if proper protocol is not followed [10][11][12]. However, most researchers agree that the management of this infection requires isolation and identification of microbial flora, appropriate antibiotic therapy according to the local sensitivity pattern, proper selection and identification of chronic complications and appropriate surgical intervention for this complication [7].…”

Sentinel Lymph Node Biopsy for Gastrointestinal Cancers

“…Direkt grafi, Amerikan Radyoloji Koleji'nin Uygunluk Kriterleri (21) listesine göre en uygun yöntem olarak kabul görse de, osteomiyelitin tanısında düşük duyarlılık ve özgüllüğe sahip olup, tutulum direkt grafi ile iki hafta sonra görülebilmektedir (13,22). Kemik demineralizasyonu, periost reaksiyonu ve kortikal destrüksiyonu tespit edebilir; ancak, bu bulguların direkt grafide görülebilmesi için, enfeksiyonun başlangıcından sonra 14 günlük bir süre geçmesi gereklidir.…”

“…DA'da saptanan patolojilerde duyarlılık ve özgüllük oranı, sırasıyla, %90 ve %83 olup diğer yöntemlere oranla oldukça yüksektir (21,28). Osteomiyelit açısından, direkt grafi ve şüpheli durumlarda, MR görüntüleme önerilmektedir (13,29,30). Ancak, kemik ödemine neden olan cerrahi durumlarda özgüllüğü etkilenir (31).…”

Diagnostic Accuracy and Surgical Utility of MRI in Complicated Diabetic Foot

“…In diabetic foot with ulceration, infection is fairly common and is main reason for hospital admission [1]. Infection in diabetic foot is usually caused by direct spread from skin ulcer which leads to various pathologies affecting musculoskeletal structure.…”