Skin Necrosis of Diabetic Foot and Its Management
The chapter describes the statistics related to diabetic foot ulceration, pathology of necrosis formation, types of necrosis, and the current surgical management of diabetic foot skin necrosis.
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36
Joon Pio Hong
Contents
36.1
36.1
Introduction ..............................................
36.2
Risk Factors for Diabetic Foot Skin Necrosis ............................................
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36.3 36.3.1 36.3.2 36.3.3
Clinical Presentation................................ Detecting Early Change ............................. Wet Necrosis .............................................. Dry Necrosis ..............................................
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36.4 36.4.1 36.4.2 36.4.3
Treatment and Reconstruction ............... Debridement............................................... Vascular Intervention ................................. Reconstruction Using Free Flaps ...............
215 215 216 217
References ...............................................................
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J.P. Hong, MD, PhD, MMM Department of Plastic Surgery, Asan Medical Center, Univeristy of Ulsan, Seoul, Korea e-mail: [email protected]
Introduction
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The chapter describes the statistics related to diabetic foot ulceration, pathology of necrosis formation, types of necrosis, and the current surgical management of diabetic foot skin necrosis. According to the statistics given in the USA, approximately 3–4 % of individuals with diabetes currently have foot ulcers or deep infections and 25 % will develop foot ulcers sometime during their life [24, 30]. Their risk of lower leg amputation increases by a factor of 8 once an ulcer develops. It is estimated that the ageadjusted rate of lower extremity amputation in diabetic patients is 15-fold that of nondiabetics [20]. Intractable diabetic foot ulcers can bring not only decreased physical, emotional, and social functions but huge economic impact to the patient [1, 25, 27]. Furthermore, the 5-year mortality after major amputations may range from 39 % to as high as 80 % [24, 21]. The necrosis is often seen in the late stages of the diabetic foot. The presence of skin necrosis is a serious implication leading to the loss of limb. Their respective indications vary depending essentially on criteria like the hardness of the black cover and the extent of necrosis in depth, the extent of necrotic tissue over the skin. In neuropathic foot, infection is usually the cause, whereas it can be solely due to ischemia alone with slow onset of mummification like dry necrosis.
L. Téot et al. (eds.), Skin Necrosis, DOI 10.1007/978-3-7091-1241-0_36, © Springer-Verlag Wien 2015
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J.P. Hong
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Fig. 36.1 Patient with wet necrosis extending to the deep fascia tissue and debridement was performed. Note the extent of necrosis after the debridement of all necrotic tissue
36.2
Risk Factors for Diabetic Foot Skin Necrosis
Risk factors involved for ulceration are peripheral neuropathy, vascular disease, limited joint mobility, foot deformities, abnormal foot pressures, minor trauma, history of ulceration or amputation, and impaired visual acuity [12]. Superimposed with infection in neuropathic or neuroischemic types will lead to wet necrosis, whereas occlusion of arteries will lead to
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