Limb Salvage in Diabetic Foot Infection

Abstract

BACKGROUND Diabetic foot infections are a frequent clinical problem. About 50% of patients with diabetic foot infections who have foot amputations die within five years. Properly managed most can be cured, but many patients needlessly undergo amputations because of improper diagnostic and therapeutic approaches. Limb salvage procedures may prevent eventual limb loss, the need of a major limb amputation, decrease total cost and may restore full ambulation earlier. MATERIALS AND METHODS Seventy five septic diabetic feet were treated with NPWT between 2014 and 2016. Debridement with or without partial foot amputation was followed. Wound progress was measured using a digital scanner. A limb was considered salvaged if complete healing was achieved without any or with minor amputation through or below the ankle. RESULTS In this series, 33 cases were managed initially by debridement and slough excision, 11 patients underwent incision and drainage for abscess and three patients underwent fasciotomy. Seven cases who presented with gangrene of toes were treated with ray amputation. Below-knee amputation was done in 21 cases. In most of the cases, limb salvage was possible. CONCLUSION A comprehensive treatment approach incorporating surgical and nonsurgical therapies are required to avoid major limb amputations in severe diabetic foot infections.