Limb Salvage in Peripheral Vascular Disease, in Diabetes Mellitus with Concept of Toe and Flow
Creators: name: Shaik, Reena KOusar
Publisher: name: Zenodo
Year: 2023

description: Limb Salvage in Peripheral Vascular Disease, in Diabetes Mellitus with Concept of Toe and Flow

Dr. Ganesh Shinde. DNB General Surgery *1, Dr. Arun Bal. MS, Phd 2 

*Correspondence to: Dr. Ganesh Shinde, DNB General Surgery, S. L. Raheja (A fortis Associate) Hospital, Mahim, Mumbai, India.

Copyright© 2023: Dr. Ganesh Shinde. This is an open access article distributed under the Creative Commons Attribution   License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original       work is properly cited.

Received:  25 November 2023

Published: 06 December 2023

 

Abstract

Background: 

Peripheral neuropathy, retinopathy, nephropathy, vasculopathy and reduced immunity are well documented complications of long-standing diabetes mellitus. Diabetic foot is a complication because of peripheral neuropathy, vasculopathy and reduced immunity in varied grades and severity. Improving blood flow by revascularization reestablishes nutrient and oxygen supply to compromised tissues in diabetic foot. In my thesis we assess outcome of revascularization in Diabetic Foot patients. 

Objective: 

Analyze advantage of complete assessment of limb by toe and flow approach followed by revascularization. 

Material Method: 

Sixty-Seven diabetic patients in Multispecialty hospital with dry gangrene of single/multiple toe/s or gangrenous foot patch, plantar ulcer with callus or non-healing wounds, and any of above presentation associated with foot infection were enrolled over one year. These patients were offered standard approach of complete diabetic foot assessment along with handheld doppler assessment of lower limb distal pulses. Patients with monophasic flow on handheld doppler assessment were treated with peripheral angiography followed by angioplasty. These patient post angioplasties were reviewed with handheld doppler for success of revascularization. They were further treated with additional surgical procedures; appropriate culture specific antibiotic treatment and offloading advise to achieve wound healing. They were followed till end of study period of one year.

Results: 

Of 67 patients studied; 29 (43 %) had gangrene, 27 (40 %) had foot ulcer, 9 (13.4 %) had foot infection, and 2 (3 %) had gangrene with ulcer. Mean age of presentation was 68 years of which 80 % were male and 20 % were female. After completing diabetic foot assessment with handheld doppler 47 (70.1 %) patients underwent lower limb angioplasty. 2 (4.3 %) of those angioplasties were unsuccessful. 20 (29.9 %) of 67 patients did not required angioplasty. 33 (49.3 %) patients required minor procedures on foot, 2 (3 %) required higher amputation and 32 (57.7 %) patients did not required any further operative procedure on the affected foot. 54 (80.6 %) were healed and 13 (19.4 %) were healing till end of one year study.

Conclusion:

Diabetic foot gangrene or ulcers managed with toe and flow approach can help to plan revascularization in diabetic foot patients. These patients do require multiple minor procedures along with culture specific antibiotics and continuing offloading after revascularization to achieve wound healing.