Plastic surgery and diabetic foot

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Plastic surgery and diabetic foot

• By
• Hanaa Tashkandi

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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.

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Clinical presentation

• Foot ulceration.
• Foot infection.
• Foot gangrene.

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Indications for amputations in diabetic patients

• severe sepsis.
• major tissue loss.
• non reconstructable vascular disease.

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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.

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Anatomical and physiological facts of the foot
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Anatomy of the foot
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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.

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• The floor
• the planter fascia .
• The roof
• the interosseous muscles and metatarsal
  bones.

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• 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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note

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

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Pathophysiology of diabetic foot

• Peripheral neuropathy.
• Peripheral vascular disease.
• Hematological abnormalities.
• Immune system impairment.

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management

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

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Pre operative evaluation

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

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Revascularization vs. amputation

• 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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Wound management

• Debridement .
• Drainage of abscess.
• Application of local antibacterial agents.

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Soft tissue reconstruction

• 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.

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Adjuvant plastic surgery procedures
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Thank you