Title:The Management of the Infected Diabetic Foot
Volume: 9
Issue: 1
Author(s): Carlo Caravaggi, Adriana Sganzaroli, Paolo Galenda, Matteo Bassetti, Roberto Ferraresi and Livio Gabrielli
Affiliation:
Keywords:
Charcot Neuroarthropaty, Diabetic foot, Diabetic foot infection, Diabetic foot surgery, Diabetic foot ulcer,
Ischemic 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.
