title: The management of the infected diabetic foot.
abstract: Diabetes is a chronic disease with a worldwide increasing trend. Foot complications, closely related to neuropathy and obstructive peripheral vascular disease, are responsible for more than 1 million of leg amputations every year. Foot infection can dramatically increase the risk of amputation. Although many ulcer classification systems have been proposed to stratify the severity of the infectious process, the definition of a specific therapeutic approach still remains an unsolved problem. A Diabetic Foot Triage and an Integrated Surgical Protocol are proposed to identify a diagnostic flowchart and a step-by-step surgical protocol that can be applied in the treatment of diabetic foot infection. Considering the rapid climbing of multidrug resistant strains it is very important to rationalize the use of antibiotics utilizing them only for the treatment of true infected ulcers. PAD is widely considered the most important factor conditioning the outcome of a diabetic foot ulcer. Currently no randomized control trials are reported in the international literature directly comparing open versus endovascular revascularisation in diabetic patients with CLI. Insufficient data are available to demonstrate whether open bypass surgery or endovascular interventions are more effective in these patients. A decisional flow chart in choosing the best revascularization strategy in diabetic patients with CLI is proposed. Goals and technical aspects of emergency and elective surgical procedures in diabetic foot are analysed to evaluate critical aspects and to suggest proper surgical choices.
authors.affiliation: Diabetic Foot Clinic, Istituto Clinico Città Studi, Via Ampère 47, Milan, Italy. caravaggi@me.com
authors.forename: Carlo
authors.initials: C
authors.lastname: Caravaggi
authors.forename: Adriana
authors.initials: A
authors.lastname: Sganzaroli
authors.forename: Paolo
authors.initials: P
authors.lastname: Galenda
authors.forename: Matteo
authors.initials: M
authors.lastname: Bassetti
authors.forename: Roberto
authors.initials: R
authors.lastname: Ferraresi
authors.forename: Livio
authors.initials: L
authors.lastname: Gabrielli
mesh_terms: D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017719:Diabetic Foot / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery / Q000628:therapy*; D018450:Disease Progression; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D023821:Limb Salvage; D008297:Male; D010019:Osteomyelitis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors; D014218:Triage / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents