DIABETIC FOOT;

SURGICAL MANAGEMENT

Abstract

Objective: Diabetic foot is one of challenging diseases based on uncontrolled diabetes mellitus. The aim of this study was to
evaluate the surgical management in diabetic foot patients presenting with different grades of infection. Design: Descriptive study. Place and
duration of study: Surgical unit I, Department of Surgery at Nishtar Hospital Multan for a periods of two years from January 2009 to December
2010. Patients and methods: A total of 120 diabetic patients with different severity of foot infections who presented in causality and surgical
outpatient department Nishtar Hospital Multan, where included in this study. Patients included in this study were above age of twelve years and
were of both sexes. A detailed history was taken followed by the clinical examination. Routine investigations including complete blood
examinations, complete urine examination, renal parameters, X-ray foot, CXR, ECG and pus for culture and sensitivity were recorded. Lesions
were raded according to Wagner classification and appropriate medical and surgical treatment carried out. Results: This study was carried out
on 120 diabetic patients, out of which ninety six (80.0%) were male and twenty four (20%) were female. Male to female ratio was 4:1. Majority of
the patients (n=66) were between the age group of 50 to 60 years. In majority of these patients forefront was involved, mostly big or little toe,.
Patients were grouped into five grades according to the severity of infection. Twenty six (21.6%) patients were managed with antibiotics and
dressings, thirteen (10.8%) patients needed debridement and skin grafting while eighty-one needed amputations of different types.
Staphylococcus aureus was the commonest organism isolated. Conclusions: Majority of the diabetic foot lesions were in grade II to V. Lesser
grade lesions responded well to conservative management with antibiotics, dressings and debridement. While those with higher grades needed
amputations. Basic principles of management include early detection of diabetic foot, proper control of infection, control of diabetes mellitus and
wound care. Delayed and improper treatment leads to osteomyelitis resulting in amputation and permanent disability of deformity