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Diabetic Foot Ulcers
Dr Brian Richman Offline
#1 Posted : Monday, April 4, 2011 12:24:48 PM(UTC)
Dr Brian Richman

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Diabetic foot ulcers can lead to infection, osteomylitis, amputation. If you surgically correct to deformity causing the diabetic foot ulcer as soon as possible before infection can occur. You can significantly reduce the complications of infection /osteomylitis / amputation. For example if the patient has a distal toe ulceration from a hammertoe deformity, correct the hammertoe and it will heal the ulcer within 1 month. Do not let the patient get their foot wet until incision is healed usually within 3 -4 weeks . Another example ulcer sub 1st metatarsal, think of surgically removing tibial sesamoid through a medial incision with possible plantar exostecomy 1st metatarsal. Usually these ulcers heal within 4 weeks. I usually use a pluse Vac flush of 6,000 cc of saline and bactracin solution intra operative correcting these ulcerations. Please let me know if I can help with any diabetic ulcerations Thanks Dr Brian Richman
1 user thanked Dr Brian Richman for this useful post.
Mason on 4/13/2011(UTC)
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Mason Offline
#2 Posted : Wednesday, April 13, 2011 12:29:18 PM(UTC)

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Originally Posted by: Dr Brian Richman Go to Quoted Post
Do not let the patient get their foot wet until incision is healed usually within 3-4 weeks.

Dr. Richman, thanks for this article. I'm sorry I cannot recall, but I saw on this forum a very simple advice how to keep the patient foot dry. I think it was in some video presentation, but cannot find it now. I will forward you the link when I find it.
Benjamine41 Offline
#3 Posted : Saturday, November 26, 2011 4:07:06 AM(UTC)

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Diabetics are prone to foot ulcerations due to both neurologic and vascular complications.
Peripheral neuropathy can cause altered or complete loss of sensation in the foot and /or leg. Similar to the feeling of a "fat lip" after a dentist's anesthetic injection, the diabetic with advanced neuropathy looses all sharp-dull discrimination. Any cuts or trauma to the foot can go completely unnoticed for days or weeks in a patient with neuropathy. It's not uncommon to have a patient with neuropathy tell you that the ulcer "just appeared" when, in fact, the ulcer has been present for quite some time. There is no known cure for neuropathy, but strict glucose control has been shown to slow the progression of the neuropathy.
Charcot foot deformity occurs as a result of decreased sensation. People with "normal" feeling in their feet automatically determine when too much pressure is being placed on an area of the foot. Once identified, our bodies instinctively shift position to relieve this stress. A patient with advanced neuropathy looses this important mechanism. As a result, tissue ischemia and necrosis may occur leading to plantar ulcerations. Microfractures in the bones of the foot go unnoticed and untreated, resulting in disfigurement, chronic swelling and additional bony prominences.
Microvascular disease is a significant problem for diabetics and can lead to ulcerations. It is well known that diabetes is called a small vessel disease. Most of the problems caused by narrowing of the small arteries cannot be resolved surgically. It is critical that diabetics maintain close control on their glucose level, maintain a good body weight and avoid smoking in an attempt to reduce the onset of small vessel disease.
Treatment: First, you must determine the cause of this ulcer. Is it neuropathic, ischemic or a combination? Base your treatment protocol on the etiology of the ulcer. Assuming that there is adequate perfusion to heal a plantar ulcer, one should have appropriate shoe modifications made to disperse weight away from the ulcerative area. Absorb any excess discharge and maintain a moist wound environment with appropriate product selection. Keep the wound edges dry. Make sure no sinus tracking occurs. Watch for infection. Debride necrotic debris and the hyperkeratotic rim as they are niduses of for infection.
1 user thanked Benjamine41 for this useful post.
Forum Admin on 11/26/2011(UTC)
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