Diabetic Foot Ulcers: Conservative Management as Limb Salvage  

Oleh:

Khallaf, Abdel-Nasser M. ; Fath, Osman ; Ayad, Wael ; Fawzi, Ashraf

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: SGH Medical Journal vol. 1 no. 2 (Jul. 2006), page 138.
Topik: diabetic foot ulcers; osteomyelitis; ulcers; foot infection.

Ketersediaan

Perpustakaan FK Nomor Panggil: S09.K Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

The diabetic foot ulcer remains a difficult clinical infection, often resulting in disability and amputation. Standard management consists of thorough removal of all infected tissues in conjunction with antimicrobial therapy. This may have an untoward effect on foot mechanics and may increase the risk of future ulcer events. In order to evaluate the efficacy of a more conservative approach, we retrospectively assessed the outcome of patients managed by an interdisciplinary team of comprehensive inpatient and outpatient care. Over a two-year period, 50 patients were identified by a discharge database; of these, 30 had outpatient followup records of more than 12 months, while the rest of the patients (20 patients) of 6 months. The treatment regimen consisted of conservative debridement or surgery, two to five weeks of empiric intravenous antibiotics, and biomechanical offloading of pressure impediments to wound healing. Initial procedures were debridement (35 patients), excision of necrotic bone (5 patients), toe or ray amputation (8 patients), and major amputation (2 patients). At twelvemonth follow up, twenty patients failed treatment, with nine patients having persistent ulcers, and two patients requiring amputation. Three patients had ulcer recurrence and 15 patients had new ulcer episodes in the follow-up observation period. The remaining 30 patients healed. In conclusion, an approach to the diabetic foot ulcer that is based on conservative surgical intervention, long-term empiric antibiotics, and interdisciplinary wound care and offloading may be a safe and effective alternative to amputation in selected patients.

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