who should treat the diabetic foot? mohammed y al-naami, frcsc

WHO SHOULD TREAT THE WHO SHOULD TREAT THE DIABETIC FOOT?DIABETIC FOOT?

Mohammed Y Al-Naami, FRCSC

Is it a debatable issue?Is it a debatable issue?

• General Surgeon• Vascular Surgeon• Orthopedic Surgeon• Plastic Surgeon• Podiatrist• May be others?

The General Surgeon The General Surgeon

Dr. we have a septic diabetic foot case

Can you take care of that Dr.?

Yes, I can chop it off, but please don’t ask me

more than that

The Vascular SurgeonThe Vascular Surgeon

• Are there pedal pulses?• Yes, Sir. • Please refer to General Surgery• No, Sir.• Please check with the doppler sounds• Pedal pulses are audible, Sir• Please refer to the General Surgeon

The Vascular SurgeonThe Vascular Surgeon

• There are no audible doppler sounds, Sir.

• A~~h, from where you bring me these cases

• Please try with general surgery again!

• Sir, they wont accept this case

• Ok. Ok. Get the patient inn and I’ll see him/her later today or tomorrow

The Orthopedic SurgeonThe Orthopedic Surgeon• Does the patient has any osteomilitis?

• Yes, Sir

• Can you try with General Surgery to take

care of this patient

• They wont accept this patient, Sir

• Ok. Ok. Get the patient inn and consult I.D.

The I.D. ConsultantThe I.D. Consultant

• Thank you for referral.

• However, I need bone biopsy from the

affected parts

• Please do this and this and this ………

• Antibiotics for at least 6 weeks

The Plastic SurgeonThe Plastic Surgeon• Is there any active infection?• Yes, Sir• Please refer case to General Surgery, and if they

need us again they can call us• No, Sir• Ok. We can see the patient later• Next day: By the way where is that patient that

you have called me for yesterday?• He/She is in ward ..and bed..• One week later: Nurse, where is the patient of

Dr……..

The PodiatristThe Podiatrist

• We have a case for you, Sir.• Ok. Can you call the senior surgical resident

to see the patient first and let him call me• Please.• Ok., Sir• Senior resident & Podiatrist: After a very

long conversation,

The PodiatristThe Podiatrist

• Ok. Please consult:

• Vascular Surgery &

• Do MRI

May be Others?May be Others?

• WHO CARES!

WHO SHOULD TREAT THE WHO SHOULD TREAT THE DIABETIC FOOT?DIABETIC FOOT?

• Treatment depends on proper limb and foot evaluation

• Evaluation includes:• History and Physical• Labs and Radiological studies• Vascular Assessment• Neurological Assessment

Vascular AssessmentVascular Assessment

• Evaluation of pulses

• Evaluation of Skin

• Doppler Waveform Analysis, Segmental

Limb Pressures, and Transcutaneous

Oxygen Tension

• Arteriography

CONCLUSIONCONCLUSION

• Treatment of a diabetic foot requires

multidisciplinary approach

• The Vascular Surgeon has a major role in

evaluation and treatment of diabetic feet

• Arterial reconstruction may improve wound

healing and halts neuropathy

CONCLUSION Cont.CONCLUSION Cont.

• Control of sepsis should be the prime goal before any further detailed assessment and medical management

• Prevention of foot wounds and fissures can be facilitated by Physicians and Educators

THANK YOUTHANK YOU