Management of diabetic foot: Brief synopsis for busy orthopedist.

Tae Hwan Park, Ashish Anand
Author Information
  1. Tae Hwan Park: Buleun Health Care Center, Incheon, Republic of Korea.
  2. Ashish Anand: Staff Orthopaedic Surgeon, VAMC, Jackson, MS, USA.

Abstract

According to available medical reports, over 10% of diabetic patients will develop foot ulcers during their lifetimes. This condition still remains great challenges to many clinicians. Various mechanisms may explain treatment-resistant entity. Treatment varies widely, relying on the severity of the ulceration as well as the presence of infection or ischemia. However, the most important things to keep in mind should consist of the following: 1) appropriate debridement; 2) off-loading of pressure; 3) effective control of infection; 4) local wound care strategy; 5) timely reconstructive surgery. The ideal flap for diabetic foot reconstruction should provide a well-vascularized tissue to control infection, adequate contour for footwear, durability, and solid anchorage to resist shearing forces. A thorough assessment of patient's general condition and voluntary motivation of the patient should be warranted to prevent any sort of postoperative recurrence.

Keywords

References

  1. Circulation. 1999 May 4;99(17):2239-42 [PMID: 10226087]
  2. Wound Repair Regen. 2000 May-Jun;8(3):162-8 [PMID: 10886806]
  3. J Am Pharm Assoc (Wash). 2000 Sep-Oct;40(5 Suppl 1):S40-1 [PMID: 11029863]
  4. Int J Artif Organs. 2000 Dec;23(12):831-3 [PMID: 11197742]
  5. Arch Dermatol. 2001 Oct;137(10):1288-90 [PMID: 11594851]
  6. J Am Podiatr Med Assoc. 2002 Jul-Aug;92(7):405-8 [PMID: 12122129]
  7. Circulation. 2002 Nov 26;106(22):2781-6 [PMID: 12451003]
  8. Cochrane Database Syst Rev. 2002;(4):CD003556 [PMID: 12519603]
  9. BMJ. 2003 May 3;326(7396):977-9 [PMID: 12727775]
  10. Circ Res. 2003 Jun 13;92(11):1247-53 [PMID: 12730094]
  11. J Vasc Res. 2003 Jul-Aug;40(4):368-77 [PMID: 12891006]
  12. Wound Repair Regen. 2003 Nov-Dec;11(6):458-61 [PMID: 14617286]
  13. J Reconstr Microsurg. 2003 Nov;19(8):543-53 [PMID: 14722842]
  14. Cochrane Database Syst Rev. 2004;(2):CD004123 [PMID: 15106239]
  15. Growth Factors. 2004 Jun;22(2):111-9 [PMID: 15253387]
  16. Ostomy Wound Manage. 2004 Apr;50(4B Suppl):3S-27S [PMID: 15311482]
  17. Ostomy Wound Manage. 2004 Apr;50(4A Suppl):9-12 [PMID: 15317237]
  18. Diabetes. 2004 Sep;53(9):2509-17 [PMID: 15331568]
  19. Plast Reconstr Surg. 2005 Jan;115(1):142-7 [PMID: 15622244]
  20. Diabetes. 2005 May;54(5):1543-51 [PMID: 15855344]
  21. Ann Plast Surg. 2005 Jul;55(1):81-6; discussion 86 [PMID: 15985796]
  22. Plast Reconstr Surg. 2005 Aug;116(2):532-8 [PMID: 16079687]
  23. Lancet. 2005 Nov 12;366(9498):1704-10 [PMID: 16291063]
  24. Mol Cell Biochem. 2006 Jan;281(1-2):163-71 [PMID: 16328969]
  25. Lancet. 2006 Mar 4;367(9512):725-6; author reply 726-7 [PMID: 16517263]
  26. Lancet. 2006 Mar 4;367(9512):726; author reply 726-7 [PMID: 16517266]
  27. Ann Plast Surg. 2006 Apr;56(4):394-8; discussion 399-400 [PMID: 16557070]
  28. J Burn Care Res. 2006 Mar-Apr;27(2):202-5 [PMID: 16566566]
  29. Curr Opin Hematol. 2006 May;13(3):175-81 [PMID: 16567962]
  30. Plast Reconstr Surg. 2006 Apr 15;117(5):1599-608 [PMID: 16641732]
  31. Plast Reconstr Surg. 2006 Jun;117(7 Suppl):143S-149S; discussion 150S-151S [PMID: 16799381]
  32. Plast Reconstr Surg. 2006 Aug;118(2):390-7; discussion 398-400 [PMID: 16874208]
  33. J Dermatol Sci. 2007 Mar;45(3):193-201 [PMID: 17270401]
  34. Int Wound J. 2007 Mar;4(1):79-86 [PMID: 17425550]
  35. Harefuah. 2007 Mar;146(3):223-7, 244-5 [PMID: 17460932]
  36. Plast Reconstr Surg. 2007 Aug;120(2):407-11; discussion 412-3 [PMID: 17632341]
  37. Diabetes Res Clin Pract. 2007 Dec;78(3):405-11 [PMID: 17655964]
  38. J Surg Res. 2007 Nov;143(1):35-42 [PMID: 17950070]
  39. Clin Plast Surg. 2007 Oct;34(4):731-4 [PMID: 17967626]
  40. Singapore Med J. 2008 Feb;49(2):105-9 [PMID: 18301835]
  41. Wound Repair Regen. 2008 Mar-Apr;16(2):169-74 [PMID: 18318802]
  42. Plast Reconstr Surg. 2008 Apr;121(4):1135-43 [PMID: 18349630]
  43. Eur J Vasc Endovasc Surg. 2008 Oct;36(4):438-48 [PMID: 18675559]
  44. Evid Based Nurs. 2008 Oct;11(4):116 [PMID: 18815328]
  45. Plast Reconstr Surg. 2008 Nov;122(5):1341-51 [PMID: 18971717]
  46. J Orthop Res. 2009 Aug;27(8):1074-81 [PMID: 19170096]
  47. Int J Low Extrem Wounds. 2009 Mar;8(1):11-8 [PMID: 19189997]
  48. Eur J Dermatol. 2009 Sep-Oct;19(5):461-8 [PMID: 19638336]
  49. Adv Skin Wound Care. 2010 Mar;23(3):116-9 [PMID: 20177164]
  50. Plast Reconstr Surg. 2010 Mar;125(3):944-52 [PMID: 20195121]
  51. Ostomy Wound Manage. 2010 Jun;56(6):32-5 [PMID: 20567052]
  52. Plast Reconstr Surg. 2010 Jul;126(1):87-96 [PMID: 20595860]
  53. Plast Reconstr Surg. 2010 Oct;126(4):1253-61 [PMID: 20885246]
  54. J Clin Nurs. 2011 Jan;20(1-2):86-93 [PMID: 21083786]
  55. Plast Reconstr Surg. 2011 Aug;128(2):387-94 [PMID: 21788830]
  56. Clin Plast Surg. 2012 Jul;39(3):341-52 [PMID: 22732380]
  57. Int Wound J. 2014 Aug;11(4):373-8 [PMID: 23078553]
  58. J Plast Reconstr Aesthet Surg. 2013 Feb;66(2):243-50 [PMID: 23098584]
  59. Int Wound J. 2013 Oct;10(5):493-500 [PMID: 23902526]
  60. Diabetologia. 1978 Mar;14(3):141-8 [PMID: 350680]
  61. J Vasc Surg. 1995 Jan;21(1):71-8; discussion 79-81 [PMID: 7823364]
  62. Plast Reconstr Surg. 1994 Nov;94(6):834-40 [PMID: 7972430]
  63. Diabete Metab. 1993 Nov-Dec;19(6):586-9 [PMID: 8026611]
  64. J Am Coll Surg. 1996 Jul;183(1):61-4 [PMID: 8673309]
  65. Diabetes Res Clin Pract. 1996 Mar;31(1-3):115-8 [PMID: 8792110]
  66. J Foot Ankle Surg. 1997 May-Jun;36(3):240-54 [PMID: 9232507]
  67. Am J Surg. 1998 Aug;176(2A Suppl):74S-79S [PMID: 9777976]

Word Cloud

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