Mistakes To Be Avoided While Diabetic Foot Surgery

1. Mistakes To Be Avoided While Diabetic Foot Surgery

2. Introduction • Diabetes is a chronic disease that impairs the body's ability to metabolize blood sugar (glucose). Over time, high blood sugar levels can damage nerves and blood vessels, leading to complications like diabetic foot. This refers to foot problems due to nerve damage and poor circulation in the feet. Patients with diabetic foot are at high risk of developing foot ulcers and infections that may ultimately require amputation. Surgeons must avoid certain pitfalls and mistakes that can lead to post-operative complications. Let us look at the 8 common mistakes to be avoided with diabetic foot surgery.

3. Not controlling blood sugar before surgery Poor blood sugar control around the time of surgery significantly increases the risk of post-operative complications like infections and poor wound healing. It is critical to optimize glucose levels and HbA1c counts before planning any foot surgery for diabetic patients. Surgery should be postponed if blood sugars are not at target levels. Not checking the vascular status The vascular surgeon must evaluate blood circulation in the affected foot and lower limb. Doppler studies and angiograms may be required to visualize the arterial flow. Any blockages or narrowing's must be addressed, and revascularization procedures should be done before debridement or reconstruction surgery. Failing to check or improve vascular supply can lead to flap necrosis and graft loss.

4. Inadequate debridement Removal of all nonviable, infected, and necrotic tissue is paramount for wound healing and prevention of re-infection. Debridement should excise unhealthy tissue until fresh bleeding bone or fascia is visible. Inadequate debridement of ulcer margins can leave behind bacteria and lead to the persistence or recurrence of infection. Serial debridement may be needed. Not obtaining cultures The surgeon must obtain cultures from deep tissues and bone during debridement to identify bacterial pathogens. This helps select appropriate antibiotic therapy. Empirical broad-spectrum antibiotics may lead to antibiotic resistance and superinfections. Culture-specific antibiotics based on sensitivity improve outcomes.

5. Poor flap and graft planning Meticulous flap and graft planning using tools, Flap selection should be based on vascular supply, defect size, location, and donor site morbidity. Perfusion assessment can confirm flap viability before surgery. Proper insetting and tension-free closure with no residual dead space prevents complications. Not offloading high-pressure areas Pressure offloading is vital postoperative care to prevent ulcer recurrence and promote healing after reconstruction. Custom orthotics, shoes, walkers, or casts may be prescribed based on location. Not offloading reconstructed areas can undo the benefits of surgery through pressure-induced ischemia. Patient education is key.

6. Delayed or inadequate wound care Meticulous local wound care is crucial after surgery to prevent wound dehiscence and infection. Wound dressings, VAC therapy, hyperbaric oxygen, and proper dressing changes promote healing. Delayed care due to poor follow-up allows contamination. Antiseptic solutions and sterile technique prevents infection. Poor glucose control post-surgery Post-operative blood glucose spikes impair immune function and wound healing. Intensive control of diet, glucose monitoring, and insulin administration is essential. Infections and poor wound healing are directly linked to sustained post-op hyperglycemia. Tight control should be continued after discharge following flap or graft surgery.

7. Conclusion • Avoiding the common mistakes outlined above will help surgeons undertake successful diabetic leg swelling treatment with improved limb salvage rates. A team approach of endocrinologists, podiatrists, vascular surgeons, orthopedic surgeons, and wound care specialists is ideal to manage these complex cases.

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