Plastic surgery and diabetic foot

1. Plastic surgery and diabetic foot By Hanaa Tashkandi

2. Scope of the problem • *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.

3. Clinical presentation • Foot ulceration. • Foot infection. • Foot gangrene.

4. Indications for amputations in diabetic patients • **severe sepsis. • **major tissue loss. • **non reconstructable vascular disease.

5. facts • 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.

6. Anatomical and physiological facts of the foot

7. Anatomy of the foot

8. There are three compartments in the sole of the foot: • -medial , lateral and central. • -are separated by the medial and lateral septae.

9. **The floor : the planter fascia . **The roof the interosseous muscles and metatarsal bones.

11. 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.

13. The dorsum of the foot: supplied by the dorsalis pedis artery. The planter of the foot: Supplied by the medial and lateral planter arteries.

15. note • The dorsalis pedis artery may be absent or rudimentary in 15% of the population.

16. Pathophysiology of diabetic foot • Peripheral neuropathy. • Peripheral vascular disease. • Hematological abnormalities. • Immune system impairment.

18. management • It is a multidisciplinary care,,, • i.e.; • general surgery. • plastic surgery. • vascular surgery.

19. Pre operative evaluation • Evaluation should focus on three major areas; • systemic CAD, pulmonary,renal,CVA. • Infection. • Neurological status. • Endocrine control.

20. Revascularization vs. amputation • Absolute indication for amputation: severe sepsis. marked tissue loss. critical cardiac and renal condition. previous experience with graft failure or thrombosis.

21. Wound management • Debridement . • Drainage of abscess. • Application of local antibacterial agents.

22. Soft tissue reconstruction • 1- management of weight bearing areas of the foot. • ---metatarsal heads. • ---the heal defect.

23. 2-non weight bearing areas. • ---forefoot. • ---instep region. • ---posterior part of hindfoot (Achilles region) • ---dorsum of the foot.

24. Adjuvant plastic surgery procedures

28. Thank you