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REVIEWS  CRITICAL LIMB ISCHEMIA AND DIABETIC FOOT: AN UPDATE 

The Journal of Cardiovascular Surgery 2013 December;54(6):755-62

Copyright © 2013 EDIZIONI MINERVA MEDICA

lingua: Inglese

The diabetic foot: a review

Ricco J. B. 1, Thanh Phong L. 2, Schneider F. 1, Illuminati G. 3, Belmonte R. 1, Valagier A. 1, Régnault De La Mothe G. 1

1 Vascular Surgery Department, Jean Bernard Hospital University of Poitiers, Poitiers, France; 2 Vascular Surgery Unit University Medical Center of Hochiminh City Hochiminh City, Vietnam; 3 The “Francesco Durante” Department of Surgery “La Sapienza” University, Rome, Italy


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Diabetic foot ulceration (DFU) is among the most frequent complications of diabetes. Neuropathy and ischaemia are the initiating factors and infection is mostly a consequence. We have shown in this review that any DFU should be considered to have vascular impairment. DFU will generally heal if the toe pressure is >55 mmHg and a transcutaneous oxygen pressure (TcPO2) <30 mmHg has been considered to predict that a diabetic ulcer may not heal. The decision to intervene is complex and made according to the symptoms and clinical findings. If both an endovascular and a bypass procedure are possible with an equal outcome to be expected, endovascular treatments should be preferred. Primary and secondary mid-term patency rates are better after bypass, but there is no difference in limb salvage. Bedridden patients with poor life expectancy and a non-revascularisable leg are indications for performing a major amputation. A deep infection is the immediate cause of amputation in 25% to 50% of diabetic patients. Patients with uncontrolled abscess, bone or joint involvement, gangrene, or necrotising fasciitis have a “foot-at risk” and need prompt surgical intervention with debridement and revascularisation. As demonstrated in this review, foot ulcer in diabetic is associated with high mortality and morbidity. Early referral, non-invasive vascular testing, imaging and intervention are crucial to improve DFU healing and to prevent amputation. Diabetics are eight to twenty-four times more likely than non-diabetics to have a lower limb amputation and it has been suggested that a large part of those amputations could be avoided by an early diagnosis and a multidisciplinary approach.

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