Mohammed Al azrak
Fayoum General Hospital, Fayoum , Egypt
Title: Stepped approach with healing promoters can decrease amputation in diabetic foot
Biography
Biography: Mohammed Al azrak
Abstract
Back ground:
Management of diabetic foot is a mission challenged by physician from different specialties; Endocrinolists, podologists, general surgeons, vascular surgeons, Plastic Surgeons and in some instances, orthopedic surgeons & diabetic foot care trained nurses . Approaches are different according to the carried back ground and facilities with the caring physician and hence the end result of management can be different .Application of plastic surgery concepts can influence the outcome as well as add to the management plane a more conservative approach and hence decrease tissue loss and avoid amputations in many instances .
Patients and methods :
Ten patients with diabetic foot and soft tissue necrosis were subjected to a more conservative approach based on keen debridement, combating infection and promoting wound healing for borderline tissues aiming at decreasing loss and facilitating regeneration and repair .
Results :
Amputation was avoided in all cases and minimal tissue loss were achieved with conservation of the limbs and positive psychological implication upon the patients and regaining daily activities.
Discussion & Conclusion:
It is found that approximately 85 % of lower extremity diabetic
amputations are preceded by a diabetic foot ulcer (DFU) and about 15 % of DFUs lead to amputation (1) .Surgical care of diabetic patients means facing a diverse spectrum of foot disease. Considering that DFU can be a significant predictor of mortality in older patients as well as 68 % increase in mortality rate in five years after amputation in certain studies, 45% in other study(2). Even after application of the five standard tenants of diabetic foot management; vascular and infection control, offloading, debridement and moist wound care, percent of cure in neuropathic ulcers in 12 weeks was 24 and 31 % of them healed at 20 weeks(3,4).So plastic surgeon approach can minimize loss and provide healing promoters .