[Interdisciplinary treatment of diabetic foot syndrome].
The amputation rate in patients with diabetic foot syndrome (DFS) in Germany is still as high as 28,000 per year. Ischemia and osteomyelitis often complicate the DFS. Impaired wound healing frequently requires further surgery with a higher amputation level. The results of treating patients with DFS in our specialized foot care center were evaluated in order to assess our interdisciplinary strategy. Advanced diabetic foot wounds in patients with ischemia and osteomyelitis first require diagnostics concerning polyneuropathy, osteomyelitis, and blood supply. If peripheral arterial vessel disease is present, surgical revascularization by distal bypass grafting is the first and crucially important element of the interdisciplinary approach. Minor amputation or elective resection of the infected bone improves wound healing. Post-interventional care for wounds with secondary healing and prevention of new ulcers are provided in a foot care clinic specialized in diabetes. The clinical and radiological results of 77 patients who underwent this treatment algorithm including bypass surgery and bone resection within 1 year were collected using a standardized questionnaire. Those results were subjected to a historical comparison. Only three patients needed further intervention because of persisting ulcers and osteomyelitis. The frequency of major amputations in all patients with DFS and ischemia combined with osteomyelitis was low (10.3%). This interdisciplinary concept of treatment guarantees a high healing rate in patients even with osteomyelitis and ischemia and allows the reduction of the rate of major amputations. The data obtained allow a fact-based design for future studies.
Eckardt
A
A
Orthopädische Klinik und Poliklinik, Johannes-Gutenberg-Universität Mainz. eckardt@mail.uni-mainz.de
Kraus
O
O
Küstner
E
E
Neufang
A
A
Schmiedt
W
W
Meurer
A
A
Schöllner
C
C
Schadmand-Fischer
S
S
D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D000792:Angiography; D001177:Arthropathy, Neurogenic / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D017719:Diabetic Foot / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D003929:Diabetic Neuropathies / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000098:blood supply*; D005858:Germany; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D010348:Patient Care Team; D055502:Secondary Prevention