Diabetic foot infection: current concepts

ABSTRACT

Diabetic foot problems are one of challenging diseases in surgical practice. They can be a major cause of disablement and have serious economic consequences for health organizations. Twenty percent of all diabetic patients are hospitalized due to foot problems at a certain time in their life. To study the various presentations, assessment, management and outcome of patients with diabetic foot infection and to plan for the future management The study included 60 patients who presented with diabetic foot infections [68 limbs]. According to Modified Wagner's classification, patients were divided into 5 grades depending on the severity of infection. Management programs and working guidelines were; pressure off- loading and non-weight bearing, control of hyperglycemia, control of infection, local wound care and dressing. Complete healing after incision and debridement was considered as an excellent result., Successful minor amputation at foot level was considered as a good result. Failure or poor results were recorded for cases with major amputations. Patient suffering from vascular lesions were excluded. Of the 68 limbs, ulceration was detected in 26 [28.2%] limbs, infection in 37 [54.4%] and osteomyelitis in 17 [25%]. The most common cultured organisms were staphylococeci [28%] followed by streptococci [20%] and pseudomonas [14%]. Mixed infection was found in 60% of the isolate. Utilized surgical incisions included web space incision, curved lateral dorsal incision, curved medial planter incision, longitudinal planter incision, transverse planter incision at the forefoot, lateral foot incision, medial foot incision, and cruciate heel incision. The overall results were good to excellent in 80.9% and poor in 19.1%. Foot ulcers and infections are serious cause of morbidity in patients with diabetes. Properly identifying and counseling persons at risk of ulceration or infection can prevent the horrible consequence such as lower extremity amputation. Aggressive and appropriate assessment and treatment of ulcers and infections together with patient cooperation decreases the morbidity of diabetic patients with sparing the foot or part of it