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