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Conservative surgery in the management of diabetic foot complications (excluding Charcot). The role of the orthopedic surgeon. | LitMetric

Conservative surgery in the management of diabetic foot complications (excluding Charcot). The role of the orthopedic surgeon.

J Clin Orthop Trauma

Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon.

Published: August 2024

AI Article Synopsis

  • Diabetic foot complications, like ulcers and infections, can lead to foot amputations and have a high risk of death over five years.
  • It's really important to try and save patients' feet to keep them physically and mentally healthy.
  • There are different types of surgeries that general orthopedic surgeons can do to help preserve the foot's function, and knowing when to use them is crucial for success.

Article Abstract

Diabetic foot complications (DFC) such as ulcers and infection are the leading cause for non-traumatic non-oncologic amputations worldwide with a 5-year mortality reaching 70 %. Every attempt is warranted to preserve the limb for physical and psychological integrity of these patients. When possible to perform, conservative surgeries could save the foot and its function. This review will focus on those procedures that do not require in-depth surgical or microsurgical skills and that could be performed by general orthopedic surgeons. Along with the technical description and specific indication, a literature search was performed to locate the evidence in relation with the efficacy of these procedures. The procedures could be described in 3 categories: bony surgeries, soft tissue procedures and orthoplastic techniques. The bones surgeries include resection arthroplasty, metatarsal osteotomy, internal pedal amputation, distal Symes amputation, cement augmentation and partial or total calcanectomy. Soft tissue procedures include Achilles tendon lengthening, gastrocnemius recession, toe flexor tenotomy and tendon transfer. The reconstructive/orthoplastic techniques include skin grafting, local flaps, fillet flap and regional flaps, mainly the reverse sural flap. Though most of these conservative surgeries have been shown to yield good to excellent results, the indication for each surgery could be confusing. The role of the orthopedic surgeon is fundamental for the optimal treatment of DFC. Though most procedures are easy to learn and to perform without the need of extra surgical skills, mastering indications is key for successful outcomes. In addition, the knowledge of these limb preserving techniques could be paramount in rural areas or if no foot and ankle surgeons are available.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367647PMC
http://dx.doi.org/10.1016/j.jcot.2024.102513DOI Listing

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