Diabetic Foot Surgical Treatment 'Limb Preserving Surgery'

Unfortunately, today, many patients with diabetic foot wounds and infections cannot access the appropriate treatment at the right time, so major amputation (mostly below the knee) is performed and limb loss occurs. Half of the cases with limb loss above the ankle level face the risk of losing their lives within 5 years. Therefore, limb-sparing surgery is extremely important in diabetic foot treatment.

Surgical treatment

Diabetic foot wounds in patients should be evaluated holistically (presence of neuropathy, state of the vascular structure and anatomical spread of the wound and infection). If there is an obstruction in the leg and foot veins, the treatment should be determined based on the vascular structure in consultation with a cardiovascular surgeon. The orthopedic physician should determine to which anatomical compartments of the foot the infection has spread and whether there is bone tissue involvement (osteomyelitis) using x-rays, scintigraphy or MRI.

In cases that do not involve localized necrosis (gangrene-blackening) at the tip of the foot, it is important to start wound care after surgical debridement of the existing wound, to detect possible microorganisms with the culture taken after debridement, and to start antibiotic treatment with the consultation of an infectious disease specialist. After infection treatment, after sufficient granulation (healing) tissue formation of the wound, the reconstruction (closure) process of the wound begins.

If there is necrosis (gangrene) in the diabetic foot wound, limited amputation is performed from the area of necrosis or the anatomical border where blood supply is better. In the presence of infection and when wound closure is not possible in a single session, open amputation is performed.

 

Wound Closure procedure; Wound closure is achieved through options such as partial skin graft application, local or free flap applications, or secondary healing if the wound volume is small.

WHAT SHOULD the treatment sequence be?

In patients with signs of sepsis due to diabetic foot infection or compartment syndrome (a condition where blood flow in the vascular bed is reduced or completely stopped due to swelling and abscess due to infection), surgical debridement should be performed by an orthopedic specialist as soon as possible to drain the abscess and reduce tissue pressure. Afterwards, treatment for vascular occlusion should be administered by cardiovascular surgery.