Diabetic foot disease: Surgery and multidisciplinary treatment
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26 Hellenic Journal of Surgery 2012; 84: 1
Diabetic Foot Disease: Surgery and Multidisciplinary Treatment Clinical Study D. Karypidis, P. Konofaos, E. Kostopoulos, G. Champsas, M. Frangoulis, A. Dounavis, F. Karantonis, A. Kostakis, O. Papadopoulos Received 02/10/2011 Accepted 10/11/2011
Abstract Aim-Background: To propose efficient therapeutic approaches leading to the control of the disease with the lowest possible impact on patients’ quality of life during and after the treatment. Patients-Methods: During the last two decades, 259 patients with diabetic foot disease have been treated. Due to the multiple locations of the ulcer sites in some patients, the overall number has risen to 264. Evaluation and classification according to stage was performed. Two hundred and twelve (80%) ulcers were neuroischaemic and 52 (16.5%) neuropathic. One hundred and forty-eight patients (57%) were men, with a mean age of 61.2 years, and 111 (43%) were women, whose mean age was 65.3 years. Surgical debridement and healing at secondary intention was followed in 152 cases. Primary amputations were performed in 71 (27%) cases. Reconstruction ranged from the use of skin grafts to free tissue transfer Results: The follow-up period ranged from 10 to 24 months (mean 17 months). Control of the disease was achieved in 146 (96%). In 13 of the patients that had previously undergone amputation, a second amputation procedure at a more proximal level proved necessary. In 41 (15.5%) patients, various reconstruction procedures were primarily performed, in 4 of which flap necrosis was observed due to thrombosis, leading to subsequent amputation. Oedema and venous congestion were minimal. No infection was observed. Conclusions: Limiting the number of amputations, following strong evidence-based criteria, and providing a functional lower limb in the best possible way constituted primary priorities in the current
D. Karypidis (Corresponding author), P. Konofaos, E. Kostopoulos, G. Champsas, M. Frangoulis, A. Dounavis, F. Karantonis, O. Papadopoulos - Plastic Surgery Department, ‘A.Sygros Hospital’ of Dermatologic Disease, University of Athens A. Kostakis - 2nd Department of Surgery, ‘Laikon General Hospital’, University of Athens e-mail: [email protected]
study. Achieving effective control of the disease, improving hospitalization conditions and minimizing overall hospital stay, offering functional and aesthetically appealing outcomes were main goals in the provided treatment. Our proposed algorithm regarding diabetic foot disease management is also included. A multidisciplinary approach was a prerequisite towards increasing patients’ postoperative quality of life.
Key words:
Diabetic Foot, Amputation, Ulcer, Reconstruction
Introduction Diabetes is a chronic disease presenting a health issue of increasing seriousness, as concerns its effects in a large number of patients. Chronic diabetic foot ulceration develops in 15% of the patients with diabetes mellitus. Currently affecting 246 million people worldwide and expected to affect 380 million b
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