Surgical treatment of the infected diabetic foot.
OBJECTIVE
In the treatment of a septic diabetic foot, you have to differentiate between a septic foot with and without ischemia. Clinical and non-invasive investigations are essential for this differentiation. The initial treatment is the same: surgical debridement and antibiotics. For foot debridement, anatomic knowledge is mandatory because massive edema can lead to a compartment syndrome of the plantar side of the foot. In case of ischemia, aggressive revascularization procedures, endovascular, surgical, or a combination should be performed to create adequate blood supply to the foot.


METHODS
In a retrospective analysis, 150 patients were reviewed.


RESULTS
In this approach, a two-year limb-salvage rate is more than 81.1% with a two-year patency of 62%. A primary amputation should be considered in case of a pre-operative mobility grade 4 or 5 (wheelchair dependency and bedridden, not able to move around).


CONCLUSIONS
With aggressive treatment with or without revascularisation procedures, limb salvage of >80% can be achieved in the infected diabetic foot.
Rauwerda
Jan A
JA
Vrije Universiteit Medical Center, Department of Vascular Surgery, Amsterdam, The Netherlands. ja.rauwerda@vumc.nl
D000368:Aged; D003646:Debridement; D003925:Diabetic Angiopathies / Q000601:surgery; D017719:Diabetic Foot / Q000150:complications* / Q000601:surgery*; D005500:Follow-Up Studies; D016523:Foot Ulcer / Q000601:surgery*; D006801:Humans; D007239:Infections / Q000601:surgery*; D009336:Necrosis; D012189:Retrospective Studies; D018805:Sepsis / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome