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Journal of the American Podiatric Medical Association
Volume 99 Number 5 454-458 2009
Copyright © 2009 American Podiatric Medical Association

Diabetic Foot Infections

Time to Change the Prognostic Concept

David L. Nielson, DPM * and Yousry Ali, MD, MSc {dagger}

* Foot and Ankle of Southwest Virginia, Roanoke, VA.
{dagger} Department of Surgery, Al-Khobar Hospital, Al-Khobar, Saudi Arabia.

Corresponding author: David L. Nielson, DPM, Foot and Ankle of Southwest Virginia, 222 Walnut Ave, Roanoke, VA 24016. (E-mail: Pampantla{at}hotmail.com)

Abstract

Patients with diabetic neuropathy are subject to ulcerations that may be complicated by infection and gangrene, with subsequent risk of amputation. It is the job of the foot specialist to identify and manage these problems early to avoid the unfortunate complication of amputation regardless of the presenting condition of the patient’s limb. We shed light on the hypothesis that suggests that infection and gangrene in a diabetic patient aggravate the degree of ischemia (microvascular, macrovascular, or both) already present enough to endanger the viability of the surrounding tissues unless urgent drainage with decompression and debridement of the necrotic sloughs is performed, with consequent reduction of tissue pressure and improvement in circulation to the area. We present cases with severe infections leading to gangrene and ischemia, which were improved following surgical management with consequent improvement in tissue viability. In these cases, we demonstrate that immediate treatment of the wound despite the delayed presentation of the patients resulted in limb salvage with much less soft-tissue loss than expected before treatment. (J Am Podiatr Med Assoc 99(5): 454–458, 2009)






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Copyright © 2009 by the American Podiatric Medical Association.