Strategic Management for Lower Limb Salvage in Diabetic Foot

Jun, Myung Gon; Ahn, Hee Chang; Park, Bong Kweon

Abstract

Diabetic foot is one of the most frequent complications with diabetic nephropathy and diabetic retinopathy in diabetic patient. Ischemia and peripheral neuropathy are the primary pathologic mechanism leading to diabetic foot. Approximately 20% of all diabetic patients admitted for foot problems, and about 80% of these patients need leg amputations. The objective of this article is to analyze the result of strategic treatment for limb salvage and to suggest appropriate surgical management in patients with diabetic foot. This study included 97 cases of treatment of diabetic foot for 6 years since August, 1995. The patients' age ranged from 34 to 83 years. There were 59 males and 38 females. According to the wound grade, extent, and involved site, we classified into 4 groups of diabetic foot. Conservative treatment was accomplished in 53 cases, local flap and/or skin graft in 13 cases, free flaps were in 12 cases, and amputations in 19 cases. The relatively superficial defects were treated with reversed adipofascial flap and split thickness skin graft. The used free flaps were 10 radial forearm free flap, 1 radial forearm osteocutaneous free flap, 1 latissimus dorsi muscle free flap. One flap loss occurred in latissimus dorsi free flap and the patient was treated with below knee amputation. The amputations included 9 toe amputations, 3 Syme amputations, 5 below knee amputations, and 2 above knee amputations. Except one patient, all patients had primary wound healing in operated site without specific complications. We conclude that selection of treatment method is very important for diabetic foot patient. Appropriate surgical treatment for limb salvage consists of infection control, coverage of exposed tendon, joint, and bone, and prevention of recurrence. In case of rapid progression of necrosis, amputations can be considered in order to prevent sepsis and provide early rehabilitation with prosthesis.