1. DIABETIC FOOT Dr Mohit Jain Associate Professor Plastic Surgery
MLN Medical College
Allahabad

2. WHO – 1995
Group of syndromes in which neuropathy, ischemia and infection lead to tissue breakdown resulting in morbidity and possible amputation

3. “PAIN – The gift nobody wants”
Paul Brand

4. What we should know
Pathophysiology
Types of Ulcers
Management
Prevention

5. Predisposing factors Peripheral neuropathy – 80% - sensory - motor
- autonomic
Peripheral vascular disease
- atherosclerosis of large vessels
Combination of both - neuroischemic

6. Pathophysiology- neuropathy
Increased intraneural concentration of sorbitol causes nerve damage
Double crush syndrome
Hyperglycemia causes decreased ability of neutrophils, macrophages and lymphocytes to destroy bacteria
Decreased ability to coat bacteria with antibiotics

7. Pathophysiology - neuropathy
autonomic neuropathy motor neuropathy sensory neuropathy anhidrosis / hyperkeratosis altered foot structure repeated trauma decreased pain Skin breakdown Wound/bacterial entry Infection

11. CHARCOT’S FOOT

14. Pathophysiology- vasculopathy
Misconception - small vessels affected
Outcome of ulcer dependant on existence of vascular disease
Simple clinical examination clinches diagnosis
Angiography required in some cases

16. Determine Aetiology Neuropathic? Vascular?
Mixed? Predominant pathology
Determine wound management
Act quickly

22. Management of neuropathic ulcers
Treat infection
Debridement of callus
Reduce pressure
Restrict walking
Dressings

28. Management of ischaemic ulcers
Vascular assessment and treatment
Treat infection
Pain management
Dressings
Avoid compression/ bandaging

29. Treatment goals Control infection Improve blood supply
Optimise wound healing environment
Protect wound from trauma

36. LOCAL AGENTS
“Never put anything in the wound, which you will NOT put in your eyes
Adequate debridement
Irrigation
Normal saline dressings
Chlorhexidine
Antimicrobial ointments
Paraffin dressings

37. Debridement (Act Quick)
Clean bone margins must be achieved
Revision surgery frequently needed
Extensive unroofing in severe necrosis
Rubber drains may not work
Closure when infection is controlled

60. THANK YOU