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Foot & Ankle Specialist
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Reviews

A Stepwise Approach to the Surgical Management of Severe Diabetic Foot Infections

Thomas Zgonis, DPM, FACFAS

John J. Stapleton, DPM

Thomas S. Roukis, DPM, FACFAS

Foot infections are common among diabetic patients with ulceration and are a major cause of hospitalization and lower extremity amputation. Aggressive and emergent surgical intervention is essential in the face of life- or limb-threatening infection to achieve limb salvage and survival. Critical limb ischemia, neuropathy, and an impaired host complicate the treatment of a severe diabetic foot infection. A severe diabetic foot infection carries a 25% risk of major amputation. For this reason, surgery should be coordinated with a well-functioning multidisciplinary team that specializes in diabetic limb preservation. Timing of surgery and strategies employed should be understood and agreed on by both the surgical and medical disciplines managing the diabetic patient with a limb-threatening infection. The overall strategy for surgically managing a severe diabetic foot infection is as follows: the first step is infection control through aggressive and extensive surgical debridement, the second step is a comprehensive vascular assessment with possible vascular surgery and/or endovascular intervention, and the final step is soft tissue and skeletal reconstruction after infection is eradicated to obtain wound closure and limb salvage. A consistent stepwise surgical approach combined with sound surgical principles is paramount for successful management of the severe diabetic foot infection. The authors discuss their stepwise surgical approach to reduce the mortality, morbidity, psychological distress, and length of hospitalization associated with life- or limbthreatening diabetic foot infections.

Key Words: diabetic foot infections • gas gangrene • osteomyelitis • diabetic neuropathy • diabetic foot surgery

References

Foot & Ankle Specialist, Vol. 1, No. 1, 46-53 (2008)
DOI: 10.1177/1938640007312316.
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This Article
Right arrow Abstract Freely available
Right arrow Free Full Text (Free PDF) Free
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
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Right arrow Add to Saved Citations
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Right arrowRequest Permissions
Right arrow Request Reprints
Right arrow Add to My Marked Citations
Citing Articles
Right arrow Citing Articles via Google Scholar
Right arrow Citing Articles via Scopus
Google Scholar
Right arrow Articles by Zgonis, T.
Right arrow Articles by Roukis, T. S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Zgonis, T.
Right arrow Articles by Roukis, T. S.
Social Bookmarking
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What's this?