The impact and outcomes of establishing an integrated interdisciplinary surgical team to care for the diabetic foot

Abstract

Interdisciplinary diabetic foot surgery teams may significantly impact surgery type, with greater focus on proactive and preventive, rather than reactive and ablative, procedures. Although endovascular limb-sparing procedures have become increasingly applicable, open bypass remains critical to success.

Building a scalable diabetic limb preservation program: four steps to success

“…If revascularization is performed by the vascular surgeon with established arterial outflow to the extremities, the podiatric surgeon may be consulted to perform appropriate reconstructive surgery or partial-foot amputations as needed [5,9,10]. Once the acute infection and/or vascular reconstruction is addressed, the patient may now move into an outpatient setting, as their active condition is no longer complicated by infective or ischemic processes, and management is now geared toward tissue loss.…”

“…Limb preservation programs consists of interdisciplinary teams that work synergistically to exchange information, discuss assessment, and create joint plans to achieve the goal of limb salvage in an integrated model. This model often incorporates podiatric and vascular surgeons (‘Toe and Flow’ model) as the core of an interdisciplinary team but which may include a diverse group of health professionals [5–8]. We have previously identified seven essential skills, first described by Fitzgerald and co-workers and later refined to eight skills by Wukich and colleagues, to define the key skill sets associated with care across a limb preservation program (Table 1) [9,10].…”

“…The ability to initiate and modify culture-specific and patient-appropriate antibiotic therapy.7. The ability to perform appropriate postoperative monitoring to reduce risks of re-ulceration and infection [5,9,10]. 8.…”

Readmissions of patients with diabetes mellitus and foot ulcers after infra-popliteal bypass surgery - attacking the problem by an integrated case management model

“…Many of these may be prevented by early referral to a multidisciplinary service, aggressive treatment of infection, as well as by arterial revascularization, e.g. infrapopliteal bypasses [1,13,24,26,31], in combination with minor amputations or debridements [2,27]. Specialized post-operative wound care supports the surgical success.…”

“…Communication between in-and out-patient health care professionals is lacking, and this combined with the oft en limited experience of outpatient therapists in postoperative wound care, leads to frequent readmissions and reduces the quality of life of the patients. DFS treatment should be based on a multidisciplinary care concept [2,34] including social, medical and surgical support as well as good interdisciplinary communication [32]. In Germany, disease management programs [36] as well as successful integrated care models [12,30] were created for this purpose, resulting in low majoramputation rates and fewer hospital treatments [12].…”