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Is it a debatable issue?. General SurgeonVascular SurgeonOrthopedic SurgeonPlastic SurgeonPodiatristMay be others?. The General Surgeon . Dr. we have a septic diabetic foot caseCan you take care of that Dr.?Yes, I can chop it off, but please don't ask me more than that . The Vascular Surgeon.
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1. WHO SHOULD TREAT THE DIABETIC FOOT? Mohammed Y Al-Naami, FRCSC
2. Is it a debatable issue? General Surgeon
Vascular Surgeon
Orthopedic Surgeon
Plastic Surgeon
Podiatrist
May be others?
3. The General Surgeon Dr. we have a septic diabetic foot case
Can you take care of that Dr.?
Yes, I can chop it off, but please don’t ask me more than that
4. The Vascular Surgeon Are there pedal pulses?
Yes, Sir.
Please refer to General Surgery
No, Sir.
Please check with the doppler sounds
Pedal pulses are audible, Sir
Please refer to the General Surgeon
5. The Vascular Surgeon There are no audible doppler sounds, Sir.
A~~h, from where you bring me these cases
Please try with general surgery again!
Sir, they wont accept this case
Ok. Ok. Get the patient inn and I’ll see him/her later today or tomorrow
6. The Orthopedic Surgeon Does the patient has any osteomilitis?
Yes, Sir
Can you try with General Surgery to take
care of this patient
They wont accept this patient, Sir
Ok. Ok. Get the patient inn and consult I.D.
7. The I.D. Consultant Thank you for referral.
However, I need bone biopsy from the affected parts
Please do this and this and this ………
Antibiotics for at least 6 weeks
8. The Plastic Surgeon Is there any active infection?
Yes, Sir
Please refer case to General Surgery, and if they need us again they can call us
No, Sir
Ok. We can see the patient later
Next day: By the way where is that patient that you have called me for yesterday?
He/She is in ward ..and bed..
One week later: Nurse, where is the patient of Dr……..
9. The Podiatrist We have a case for you, Sir.
Ok. Can you call the senior surgical resident to see the patient first and let him call me
Please.
Ok., Sir
Senior resident & Podiatrist: After a very long conversation,
10. The Podiatrist Ok. Please consult:
Vascular Surgery &
Do MRI
11. May be Others? WHO CARES!
12. WHO SHOULD TREAT THE DIABETIC FOOT? Treatment depends on proper limb and foot evaluation
Evaluation includes:
History and Physical
Labs and Radiological studies
Vascular Assessment
Neurological Assessment
13. Vascular Assessment Evaluation of pulses
Evaluation of Skin
Doppler Waveform Analysis, Segmental Limb Pressures, and Transcutaneous Oxygen Tension
Arteriography
14. CONCLUSION Treatment of a diabetic foot requires multidisciplinary approach
The Vascular Surgeon has a major role in evaluation and treatment of diabetic feet
Arterial reconstruction may improve wound healing and halts neuropathy
15. CONCLUSION Cont. Control of sepsis should be the prime goal before any further detailed assessment and medical management
Prevention of foot wounds and fissures can be facilitated by Physicians and Educators
16. THANK YOU