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Surgical Intervention
- Cornerstone of treatment of many deep soft tissue infections & early intervention; may be associated w/ better outcomes
- If the patient has gas gangrene, abscess or necrotizing fasciitis, compartment syndrome or systemic sepsis, immediate surgery is recommended
- Goal of surgical treatment is to drain any deep pus & to minimize tissue necrosis by decompressing foot compartments & to remove devitalized & infected tissue
- Diabetic foot infection surgical intervention should be done by a surgeon w/ thorough knowledge of the anatomy of the foot & the path in which infection spreads through its fascial planes
- Surgical interventions that should be performed in a timely manner may include:
- Abscess incision & drainage
- Extensive debridement of necrotic & devitalized tissue
- Resection
- Amputation
- Revascularization
- Incision & drainage is the initial surgical intervention in non-urgent infections
- If the patient is not responding, further resection is needed
- Debriding necrotic tissue of wound that has a dry eschar, especially in an ischemic foot, should be avoided because often this will resolve w/ autoamputation
- Revascularization, either endovascular or open bypass, is considered for a severely ischemic infected limb in patients w/ diabetes
- Bone resection & amputation is often essential when there is extensive soft tissue necrosis or to provide a more functional foot
- A specimen of bone should be obtained at the time of surgery for analysis by culture & histopathology
- Major amputation is necessary in the following limb situations:
- Non-viable
- Affected by a potentially life-threatening infection (eg gas gangrene or necrotizing fasciitis)
- Functionally useless
- Prevention of secondary complications
