Functional reconstruction after ablative debridement for severe diabetic foot infection

Managing limb-threatening diabetic infections imposes a significant strain on both physician and patient. Patient disclosure must be thorough before undertaking the task. The possibility of prolonged hospitalization, multiple surgical interventions, prolonged rehabilitation, and the potential for loss of limb must be discussed. Patient attitude and cooperation are requisite to a favorable outcome. A staged protocol must be observed. Initial surgical debridement, local wound care, and appropriate medical management to eradicate the infectious process must precede the functional reconstruction. Surgical reconstruction should use the simplest method available that will result in a durable and functional closure. Even with the best result, the patient will forever be at a functional disadvantage with the potential for future recurrence. Appropriate accommodative footwear must be instituted to augment pressure distribution on the compromised extremity. Routine reevaluation in addition to patient education is the best assurance for a favorable, sustained outcome.