Diabetic limb salvage procedure with bone allograft and free flap transfer: a case report

Godoy‐Santos, Alexandre Leme; Amodio, Daniel Tassetto; Pires, André Fernandes; Lima, Ana Lúcia Munhoz; Wei, Teng Hsiang; Armstrong, David G.

doi:10.1080/2000625x.2016.1270076

Cited by 6 publications

(2 citation statements)

References 19 publications

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“…Moreover, PDT is an ambulatory procedure, involving a lot less costs compared with treatment modalities that require hospitalization [12–14]. It is important to mention that other non-systemic treatment modalities with or without debridement have also been shown to be effective in the treatment of the diabetic foot [15,16]. …”

Section: Introductionmentioning

confidence: 99%

Is surgical debridement necessary in the diabetic foot treated with photodynamic therapy?

Tardivo

Serrano

Zimmermann

et al. 2017

Diabetic Foot & Ankle

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Background: Diabetic patients are susceptible to developing foot ulcers with serious complications such as osteomyelitis and amputations. Treatment approaches are still empirical and the benefit of usual procedures such as surgical debridement has not been properly evaluated. Photodynamic Therapy (PDT) is a non-invasive and highly efficient method for the treatment of the diabetic foot, being able to eradicate the infection and to stimulate healing, decreasing considerably the amputation risk. In the day-to-day practice of our service, we have been faced with the question whether debridement is necessary before PDT. In here, we designed a study to answer that question. Methods: Patients were divided in two groups: In one of the groups (n = 17), debridement was performed before PDT and in the other (n = 40) only PDT treatment was performed. PDT sessions were performed once a week in all patients until healing was achieved, as indicated by visual inspection as well as by radiographic and laboratory exams. At the start of the study, the two groups had no statistical differences concerning their clinical features: average age, gender, insulin use, diabetes mellitus onset time and previous amputations. Results: PDT was effective in the treatment of 100% of the patients showing no relapses after one year of follow up. The group submitted to PDT without previous debridement had a statistically significant (p = 0.036, Mann-Whitney) shorter cure time (29 days, ~27%). Conclusion: Our data indicates that debridement is not necessary in the treatment of diabetic foot in patients that have enough peripheral arterial perfusion. In addition, we reproduced previous studies confirming that PDT is an efficient, safe, simple and affordable treatment method for the diabetic foot.

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Section: Introductionmentioning

confidence: 99%

Is surgical debridement necessary in the diabetic foot treated with photodynamic therapy?

Tardivo

Serrano

Zimmermann

et al. 2017

Diabetic Foot & Ankle

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“…For these reasons, limb salvage is preferred over proximal amputation and is well established in cases of infected neuropathic diabetic foot. 12 Before proceeding with amputation, the goals of surgery should be thoroughly considered. In this patient, the initial surgical goals were similar to those of damage-control trauma surgery, namely, reducing the risk of immediate morbidity and mortality by eliminating the infected and necrotic tissue.…”

Section: Discussionmentioning

confidence: 99%

Staged salvage of diabetic foot with Chopart amputation and intramedullary nailing

Godoy‐Santos

Fonseca

Bang

et al. 2021

SAGE Open Medical Case Reports

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We present a stepwise surgical approach that can be used, in lieu of a transtibial amputation, to preserve the lower limb in the setting of severe diabetic foot infections. A 63-year-old male status post left midfoot (Lisfranc’s) amputation presented to our hospital with a 4-year history of a left foot diabetic ulcer with associated purulent drainage and intermittent chills. On initial exam, the patient’s left foot amputation stump was plantarflexed, grossly erythematous, and edematous. The associated diabetic foot ulcer was actively draining purulent fluid. Following workup with radiography and ultrasound, the patient was diagnosed with a post-operative infection of the midfoot at the level of the amputation stump secondary to diabetic neuropathy. Our approach to management was a staged and included (1) surgical irrigation and debridement of the distal stump wound, (2) provisional negative pressure therapy, (3) a second-look procedure, and (4) a tibiotalocalcaneal fusion was performed using a lateral transfibular and plantar approach, after wound closure and resolution of active infection was achieved. At 36-month follow-up, the patient was fully weight-bearing in stiff sole sneakers with no gross overt alteration of gait pattern. The patient scored 79 points when assessed by the hindfoot American Orthopaedic Foot and Ankle Society Ankle-Hindfoot outcome score. In the patient with diabetes and cardiological restrictions, a Chopart amputation is preferred due to the decreased level of energy expenditure required for ambulation as compared to over more proximal levels of amputation.

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Diabetic Foot

Godoy‐Santos

Sposeto

2022

Foot and Ankle Disorders

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Diabetic limb salvage procedure with bone allograft and free flap transfer: a case report

Cited by 6 publications

References 19 publications

Is surgical debridement necessary in the diabetic foot treated with photodynamic therapy?

Is surgical debridement necessary in the diabetic foot treated with photodynamic therapy?

Staged salvage of diabetic foot with Chopart amputation and intramedullary nailing

Diabetic Foot

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