Management of the diabetic foot: surgical and organisational aspects

Most patients are older, but increasing numbers of young patients also develop diabetic foot ulcer (DFU). A third of the patients are under 50 years of age. The prevalence in the Western countries is 4-10% and the incidence 2-6%. Only 10-60% of patients are healed after the first three months and the recurrence rate is 44%, 61%, and 70% after one, two and three years, respectively. DFU results in extensive treatment costs, and the hospital treatment cost of DFU counts towards 25-30% of the total hospital expenses of treatment of patients suffering of diabetes. Recent progress in the treatment of patients with DFU has reduced the number of low-extremity amputation (LEA) cases. These improvements have been achieved through an increasing understanding of the importance of the multifactorial background of DFU, and that there should be a multidisciplinary organized structure behind the treatment of DFU. This used to be a topic of interest, but especially focused on the international Consensus on the Diabetic Foot from 1999. Our understanding of the importance of surgery in DFU has increased over the last 30 years. A simple classification based on presents or absents of neuropathy, open wound or infection has been suggested. Treatment is dependable of the type and classification group of the wound. Various surgical correction techniques are available. The team approach and collaboration between all healthcare professionals is required to facilitate good quality holistic care. Recognition of the talent and creativity of all employees in the multidisciplinary team will increase the chance of success in establishment of the concept. This article is based on a presentation focusing on the surgical and organisational aspects in thr treatment of DFU.