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Abstract
Diabetic foot diseases which require surgical treatment consists of diabetic foot ulcer, infection and neuropathic arthropathy. Surgical procedures for diabetic foot ulcers and infections such as drainage, debridement, partial foot amputation and major limb amputation are most common procedures and arthodesis with or without deformity correction can be performed for specific diabetic neuropathic arthropathies. Underlying pathomechanism of diabetic foot disease includes diabetic peripheral neuropathy and vasculopathy. Treating physicians should be aware that concomitant complications of long-standing diabetic status such as cardiovascular and renal dysfunction should be addressed to treat intractable diabetic foot diseases successfully. However, with advent of adjuvant treatment which increases vascular supply on ischemic limb disease, proper surgical treatment on diabetic foot disease can prevent or delay major limb amputations, sustaining functional capability of diabetic patients.
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Fig. 1.
Severe diabetic foot disease with infection was treated surgically by repeated debriment, negative pressure wound therapy (NPWT) and partial thickness split skin graft. (A) Debridment of severe diabetic foot disease with intractable infection. (B) Induction of healthy granulation tissue using NPWT. (C) Reconstruction of skin defect using split thickness skin graft after complete infection control.
Fig. 4.
Case of diabetic arthropathic patient. (A) Severe bone destruction and resorption due to diabetic neuropathic arthropathy. Usually patients complain lesser degree of pain than nonneuropathic arthritic patients because of neuropathy. (B) We achieved successful ankle fusion by stable fixation of ankle joint and addition of autogenous bone graft.
Table 1.
Wagner-Meggitt classification
Table 2.
The depth-ischemia classification of diabetic foot lesions
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