Surgical strategies for prevention of amputation of the diabetic foot

Abstract

Prevention of amputation has become a key objective of clinicians providing care to patients with highrisk diabetic foot problems. In this regard, the multidisciplinary diabetic foot team (MDFT) has been embraced as the most effective way to manage patients with foot ulcers, infections, and Charcot feet. Importantly, such specialized teams have also integrated various surgical specialties to enable more expedient management of these often complex conditions. Experienced diabetic foot surgeons over the last three or four decades have contributed much to this discipline, whereby foot-sparing reconstructive procedures or minor amputations have become fundamental strategies for limb preservation teams. Central to limb salvage, of course, is the recognition of underlying vascular insufficiency and the importance of prompt (endo)vascular intervention. Restoration of adequate perfusion is essential to allow the podiatric, orthopaedic, or plastic surgeon to perform indicated functional reconstructive or minor amputation procedures. This evidence-based overview discusses the various indications and surgical principles inherent in modern concepts aimed at preventing amputation in the high-risk diabetic foot.

Reduced Hospitalizations and Amputations in Patients with Diabetic Foot Ulcers Treated with Cyclical Pressurized Topical Wound Oxygen Therapy: Real-World Outcomes

“…While our data did not categorize specific levels of amputations performed, modern limb-salvage practice has a relatively low threshold for such minor amputations in the presence of deteriorating diabetic foot wounds. 28 This is reflected in recent nation-wide increases in the rate of diabetes-related minor amputations in the United States, manifested as a 50% increase in the total amputation rate in the years 2009–2015. 29…”

Improving Physical, Physiological, and Psychological Health Outcomes in Patients with Diabetic Foot Ulcers – State of the Art

“…Surgical correction of significant deformity should be considered soon after DFU healing has occurred, and sometime, even to achieve healing. 79 Likewise, it will be important to ensure any revascularisation undertaken during the initial phase of DFU care is monitored and pharmacotherapy adjusted to ensure long-term durability. 80 , 81 The biomechanical considerations are perhaps the most vital, representing a dynamic process and are discussed further below.…”

Prevention and Management Strategies for Diabetic Neuropathy

“…It emphasizes the importance of a multidisciplinary approach involving diabetology, podiatry, vascular surgery, orthopedics and other specialties, as well as a pathway to ensure timely footcare and urgent referral [ 108 ]. For example, transfer of care to dedicated clinics that specialize in strategies such as off-loading, debridement, managing infection and restoring arterial flow, in order to avoid amputation, are essential and provide optimal limb salvage treatment [ 66 , 87 ]. However, a recent national audit in the UK found that these services are currently fragmented and confusing, leaving patients in the community without the necessary treatment [ 88 ].…”

“…A multidisciplinary footcare team with surgical and infection expertise may provide optimal limb salvage treatment [ 87 ]…”