糖尿病足疾患の整形外科的ケアパス：英国の地方地区総合病院での経験

The diabetic foot is the major cause of non-traumatic amputations of the lower limb in the UK. There are well-established guidelines and pathways for the management of these patients in tertiary centres, but their management in district general hospitals (DGHs) remains inconsistent. The aim of this study was to describe a dedicated orthopaedic pathway, set up and managed by a multidisciplinary foot team in a DGH.

Patients are managed on either an emergency, urgent, or elective pathway. We describe how these pathways have worked in our DGH: a total of 104 patients were managed in this way between August 2019 and September 2023. Patients who were initially on the emergency pathway for a foot attack or an acute episode were moved to the urgent or elective pathway for a specialist reconstructive procedure.

A total of 29 patients were managed as an emergency, 75 as urgent, and 12 were treated on an elective pathway. Ten patients were moved from the emergency to the urgent pathway, and two from the urgent to the elective pathway. A total of 150 bony and soft-tissue reconstructive procedures were undertaken. The mean follow-up was 30 months (17 to 65), during which time ten patients died and three moved away. There were six major amputations. The rate of limb salvage was thus 93.4% (85 of 91). A total of 77 patients (84.6%) had complete resolution of their infection and wound healing, and 67 (73%) were independently mobile.

We demonstrate how an orthopaedic care pathway can be run effectively in a DGH in the UK for the management of patients with diabetic foot disease, achieving an excellent rate of limb salvage and an acceptable rate of complications.