diabetic%20foot%20infection
DIABETIC FOOT INFECTION

Diabetic foot infection occurs in patients with diabetes as they are prone to microorganism invasion and multiplication in the soft tissue or bone (anywhere below the malleoli) that leads to host inflammatory response that usually results to tissue destruction.

Staphylococci and streptococci are the most common causative organisms although most diabetic foot infections are polymicrobial.

Most infections usually start with a break in the protective cutaneous envelope of the skin that resulted from trauma or neuropathic ulceration.

Management of diabetic foot ulcer in patients with diabetes needs an interdisciplinary approach to address glycemic control, infection, offloading of high-pressure areas, lower extremity vascular status and local wound care.

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
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