Can amputation be prevented in diabetic foot? Interdisciplinary approach to diabetic foot: a case report.

ABSTRACT

Diabetic foot ulcers may result in loss of an extremity and may even lead to mortality. The use of comprehensive foot care programs which include early screening and evaluation of problems, foot care education, preventive therapy and referral to specialists has been shown to reduce amputation rates by 49-85 [percent]. A 51-year-old woman with Type 2 diabetes under surveillance for nine months was referred from the emergency department. She presented with an entirely inflamed right foot with ulcer covering two-thirds proximal of the foot for 30 days' duration. There was extensive edema as well as cellulitis extending to the knee, fluctuating abscesses and lymphangitis to the ankle. Magnetic resonance imaging showed extensive abscesses and edema in foot compartments. After a further four weeks of antibiotics, 80 sessions of hyperbaric oxygen therapy shrank the wound from 15x15x2 cm to 3x3x0.2 cm. The wound was closed with a split thickness graft, and healing completed four months after presentation. Patients with diabetic foot deserve clinical evaluations of the whole body rather than a regional treatment. An interdisciplinary approach involving both medical and surgical treatment options should be conducted according to this perspective. It could be effective in lowering major amputation rates and even preventing amputations. Simultaneously administered effective debridement methods, utilization of minor amputations for necrotic tissue and lowering the infectious load with appropriate antibiotics, aggressive wound care with the appropriate wound care products, unconventional treatment methods like hyperbaric oxygen treatment and negative pressure wound care may help reduce amputation levels and save extremities.