Download Plastic surgery and diabetic foot

By
Hanaa Tashkandi
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*20% of diabetic patients enter the hospitals for
foot problems.
*70% of major leg amputations are done in
diabetic patients.
*50% of patients will need a contralateral lower
limb amputation within two years.
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Foot ulceration.
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Foot infection.
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Foot gangrene.
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**severe sepsis.
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**major tissue loss.
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**non reconstructable vascular disease.
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The energy expenditure in an amputated
patient increase by 60%.
So because of that insufficient , most of the
amputated diabetic patients are bed or wheel
chair bound.
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There are three compartments in the sole of the
foot:
-medial , lateral and central.
-are separated by the medial and lateral septae.
**The floor :
the planter fascia .
**The roof
the interosseous muscles and metatarsal bones.
Nerve supply :
tibial nerve which enters the foot through the
tarsal tunnel.
And the sensibility is provided by the three
terminal branches of the tibial nerve.
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The dorsum of the foot:
supplied by the dorsalis pedis artery.
The planter of the foot:
Supplied by the medial and lateral planter
arteries.
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The dorsalis pedis artery may be absent or
rudimentary in 15% of the population.
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Peripheral neuropathy.
Peripheral vascular disease.
Hematological abnormalities.
Immune system impairment.
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It is a multidisciplinary care,,,
i.e.;
general surgery.
plastic surgery.
vascular surgery.
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Evaluation should focus on three major areas;
systemic CAD, pulmonary,renal,CVA.
Infection.
Neurological status.
Endocrine control.
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Absolute indication for amputation:
severe sepsis.
marked tissue loss.
critical cardiac and renal condition.
previous experience with graft failure or
thrombosis.
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Debridement .
Drainage of abscess.
Application of local antibacterial agents.
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1- management of weight bearing areas of the
foot.
---metatarsal heads.
---the heal defect.
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2-non weight bearing areas.
---forefoot.
---instep region.
---posterior part of hindfoot (Achilles region)
---dorsum of the foot.