Diabetic Foot Team

Abstract

Diabetes is a chronic disease with a worldwide increasing trend. Foot complications, closely related to neuropathy and obstructive peripheral vascular disease, are responsible for more than one million of leg amputations every year. Foot infection can dramatically increase the risk of amputation. Since 90 % of leg amputations are preceded by an ulcer, prevention acts are the key points to reduce amputation and to improve quality of life. Different professionals should be involved in a well-implemented prevention programs into a unified team with the objective to change the self-care behavior of the person with diabetes improving adherence to foot care advice. From a diagnostic point of view, many ulcer classification systems have been proposed to stratify the severity of the infectious process, but the definition of a specific therapeutic approach still remains an unsolved problem. A diabetic foot triage and an integrated surgical protocol are proposed to identify a diagnostic flow chart and a step-by-step surgical protocol that can be applied in the treatment of diabetic foot infection. Considering the rapid increase of multidrug-resistant strains, it is very important to rationalize the use of antibiotics utilizing them only for the treatment of true infected ulcers. PAD is widely considered the most important factor conditioning the outcome of a diabetic foot ulcer. Currently no randomized controlled trials are reported in the international literature directly comparing open versus endovascular revascularization in diabetic patients with CLI. Insufficient data are available to demonstrate whether open bypass surgery or endovascular interventions are more effective in these patients. A decisional flow chart in choosing the best revascularization strategy in diabetic patients with CLI is proposed. Goals and technical aspects of emergency and elective surgical procedures in diabetic foot are analyzed to evaluate critical aspects and to suggest proper surgical choices. A diabetic foot care network, well organized and extensively dealt to the territory, is the crucial point to be able to face both acute and chronic lesions. The diabetic foot care network should be characterized by different specialized diabetic foot centers according to the type of treatment to be applied to different patients.