a comprehensive approach to diabetic patient treatment
TRANSCRIPT
A comprehensive approach to diabetic patient treatment: what is standardized wound therapy and
when to perform minor amputations
Carlo Maria Ferdinando Caravaggi University Vita – Salute San Raffaele Milan (Italy)
Diabetic Foot Dept.
Istituto Clinico Città Studi Milan – Italy
Disclosure
Speaker name:
Carlo Maria Ferdinando Caravaggi
I have the following potential conflicts of interest to report:
Consulting
Employment in industry
Stockholder of a healthcare company
Owner of a healthcare company
Other(s)
I do not have any potential conflict of interest
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DIABETIC FOOT LESIONS
FEET DEFORMITIES
ACUTE ULCER
ISCHEMIA
CRONICH ULCER
INFECTION
REVASCULARISATION PROCEDURES
ENDOLUMINAL SURGICAL
DIABETIC FOOT LESIONS
FEET DEFORMITIES
ACUTE ULCER
ISCHEMIA
CRONICH ULCER
INFECTION
REVASCULARISATION PROCEDURES
ENDOLUMINAL SURGICAL
CRUCIAL
POINT
Step-by-step approach for the treatment of
infected diabetic foot with CLI
1° INFECTION TREATMENT
• ULCER DEBRIDEMENT &
URGENT SURGERY (GANGRENE/ABSCESS/
PHLEGMON)
• METABOLIC &
CARDIOLOGIC
TREATMENT
• PRE-MEDICATIONS
The goal of emergent surgery
in infected ischemic diabetic
foot is the control of local and
systemic infection. Surgery has to be performed as
soon as possible: any delay in
treating an acute lesion will reduce
the possibility to save the limb.
PVD doesn’t modify the timing of
emergent surgery in infective ischemic
foot
“Infection in diabetic foot is the primary factor for amputation from 25 to 50% of patients…” International Consensus on the Diabetic Foot &Practical Guidelines on the Management andPrevention of the Diabetic Foot 2011
CHRONIC ULCER
FEET DEFORMITIES: OFF-LOADING
Therapeutic shoes Off-loading cast
CHRONIC ULCER FEET DEFORMITIES: CORRECTIVE SURGERY
FOREFOOT
MIDFOOT
REARFOOT
Minor amputations: when to perform them
• Good blood tissue perfusion
• Foot shape non suitable for prosthesis
• Rapid back to walk
• Consider patient age and needs
Minor amputations: how to perform them “Biomechanics of feet reconstructive surgery”
Digit amputation: should be avoided because of risk of
plantar ulcer on metatarsal head
Ray amputation: must be performed proximally to avoid
plantar flection of residual bone ulcer
Minor amputations: how to perform them
“Biomechanics of foot reconstructive surgery”
Lisfranc/Chopart Amputation:
Always performed together with ankle arthrodesis to avoid
equine and supination deformity of the stump
..and finally what about dressing…
..and finally what about dressing…
There are currently no data to justify
the use of specific treatments or
dressing products (including silver-
containing dressings or other
antiseptic products) in routine
management of diabetic foot ulcers.
International Consensus on the
Diabetic Foot &Practical
Guidelines on the Management
andPrevention of the Diabetic
Foot 2011
Conclusion • Make first a correct diagnosis
• Treat infection as soon as possibile
• Correct ischemia
• Off-load the ulcer
• Correct feet deformities
• Prevent relapsing of the ulcer
..and take care of our patients for a long time...
A comprehensive approach to diabetic patient treatment: what is standardized wound therapy and
when to perform minor amputations
Carlo Maria Ferdinando Caravaggi University Vita – Salute San Raffaele Milan (Italy)
Diabetic Foot Dept.
Istituto Clinico Città Studi Milan – Italy