Surgical treatment of the ulcerated foot

Abstract

Foot ulceration with infection continues to be one of the leading causes of hospitalization for patients with diabetes mellitus. It has been previously reported that the incidence and prevalence of diabetic foot ulcerations is believed to be 15%. The rate of recidivism remains a staggering 50% with the majority of these ulcerations recurring within 18 months. This has significant economic ramifications on the health care system when one considers that the average total direct cost of healing an infected ulceration not requiring amputation is approximately $ 17,500 per episode. Successfully treating diabetic foot infections and ulcerations requires a thorough understanding of the risk factors for ulcerations and amputations. It requires taking advantage of advances in antimicrobial therapy, wound healing strategies including topical growth factors, negative pressure wound therapy (NPWT), improved vascular interventions, and a more aggressive surgical approach where indicated. The key components for successful outcomes require the establishment of treatment algorithms utilizing the above advances and the identification of a dedicated team of health care professionals to manage these complex problems.