The appropriate management algorithm for diabetic foot: A single-center retrospective study over 12 years

Area of Science:

• Reconstructive surgery
• Diabetic foot management
• Vascular surgery

Background:

• Diabetic foot presents challenges due to poor circulation and chronic infection.
• Maximizing viable tissue is crucial, but amputation is sometimes unavoidable.
• A phased management approach is essential for effective diabetic foot care.

Purpose of the Study:

• To introduce an optimal algorithm for diabetic foot management.
• Analyze over 12 years of patient cases to refine treatment strategies.
• Provide a comprehensive yet accessible treatment algorithm for successful outcomes.

Main Methods:

• Reviewed 274 diabetic foot patients (2005-2017).
• Implemented a 5-step management process: evaluation, wound prep, vascularity improvement, surgery/dressing, and rehabilitation.
• Utilized microbial cultures, vascular studies, osteomyelitis assessment, debridement, negative-pressure wound therapy, and revascularization techniques.

Main Results:

• 81% of patients had confirmed infections.
• 83.8% of vascular studies revealed arterial occlusion.
• Revision surgery rates were lower (20.6%) with complete infection eradication compared to remnant infection (40.9%).
• Successful revascularization correlated with lower revision rates (21.3%) versus no/unsuccessful revascularization (28.2%).

Conclusions:

• Diabetic foot is a complex, multifactorial disease.
• A comprehensive treatment algorithm is vital for successful diabetic foot management.
• The proposed algorithm offers a significant approach to optimizing patient outcomes.