J Korean Med Assoc.  2015 Sep;58(9):795-800. 10.5124/jkma.2015.58.9.795.

Diabetic foot ulcer

• Suh HS
• Hong JP

• KMID: 2195091
• DOI: http://doi.org/10.5124/jkma.2015.58.9.795

Abstract

The clinical significance of diabetes is increasing with a growing aged population and changes in lifestyle. Among all complications of diabetes mellitus, diabetic ulcers are the most severe and expensive. The lifetime incidence of diabetic foot ulceration is as high as 25%. Ulcers frequently become infected and are associated with the risk of limb amputation and increased mortality and healthcare costs. A specialized multidisciplinary team approach is needed to care for patients with ulceration. Comorbidities such as poor limb circulation and the loss of protective sensation due to diabetic vasculopathy and neuropathy should be treated concurrently to promote wound healing. In cases of ischemia, transluminal angioplasty or bypass surgery may enhance circulation, allowing ulcer healing or reconstructive surgery. With an integrated team approach, the major focus of ulcer treatment has changed from amputation to limb salvage. Appropriate follow-up, including the minimization of risk factors and education on foot care in daily living, is essential to prevent re-ulceration.

Keyword

Diabetic foot; Foot ulcer; Diabetes complications

MeSH Terms

Amputation
Angioplasty
Comorbidity
Diabetes Complications
Diabetic Foot*
Education
Extremities
Follow-Up Studies
Foot
Foot Ulcer
Health Care Costs
Humans
Incidence
Ischemia
Life Style
Limb Salvage
Mortality
Risk Factors
Sensation
Ulcer*
Wound Healing

Figure

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  Figure 1 Severe artherosclerosis and obstruction of lower limb arteries.

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  Figure 2 Diabetic foot ulceration with necrosis and severe infection.

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  Figure 3 Diabetic ulcer with ischemia (A). After balloon dilatation of peripheral artery there were reasonable amount of bleeding was noticed (B). After the debridement, negative pressure therapy wound therapy was done for preparation of skin graft (C,D).

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  Figure 4 Diabetic ulceration with infection (A). After wound management with negative pressure therapy (B), free tissue transfer with microanastomosis of small artery and vein smaller than 0.8 mm was done (C). Foot was salvaged (D).

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