Diabetes is a lifestyle disease which is increasing in incidence. A number of people are being affected, and the age of onset is decreasing. The issue with managing diabetes is that it is a multi-system disease, and affects almost the entire body system. The circulatory, nervous, and musculoskeletal systems and overall metabolism are all severely affected as the disease progresses. Therefore, early detection is highly helpful as it aids in controlling the progression of the disease as well as in arresting its symptoms.
Infections, especially in the leg, which lead an individual to suffer from a diabetic foot are due to two reasons:
- Nervous system: Diabetes results in a reduced sensation of the nervous system, especially in the distant organs like the toes and legs. As the sensory perception is reduced, small hurts and wounds in the legs go unnoticed and the person does not feel any pain.
- Skin: Once diabetes sets in, the collagen formation and wound-healing capability is reduced. The rate of regeneration of tissues is reduced. So in addition to the reduced sensation, the rate of healing is also reduced.
- These wound infections could be limb threatening or non-limb-threatening. As the infection progresses from mild to moderate to severe, the wound progresses from a small ulcer to cellulitis involving the infection of the subcutaneous layer. This then progresses to gangrene, which refers to the death of the underlying tissue due to chronic infection. This infection gradually reaches the bone to cause osteomyelitis.
The primary problems with severe cases of diabetic foot include:
- Hypoxia it reduces the oxygen supply
- Debris due to infection and death of subcutaneous tissue
- Nutritional deficiencies is a common side effect of diabetes
- Lack of vascularity due to atherosclerosis and arteriosclerosis
How does surgery help?
- Sharp surgical debridement: This is done in cases that only have a deep cellulitis or gangrene. The infected tissue is marked out along with a good margin of normal tissue, completely debrided leaving normal margins. This allows diagnosing the extent of the infection, clear debridement, and also promotes wound healing. The skin closure is done with skin grafts from another portion, usually the thigh or torso. Postop care is essential for success.
- Amputation: In people where the infection is quite deep, with or without osteomyelitis (bone involvement), amputation may be required. This amputation may be only of the toes, the foot, or below or above the knee depending on the stage of identification and extent of infection. This helps in improved diabetic foot control as well as re-ulceration, which can be quite complicated.
While surgery comes with its own set of complications, it sometimes helps in treating severe diabetic foot infections. In case you have a concern or query you can always consult an expert & get answers to your questions!