Surgical treatment of the infected diabetic foot

OBJECTIVES: In the treatment of a septic diabetic foot, you have to differentiate between a septic foot with and without ischemia. Clinical and non-invasive investigations are essential for this differentiation. The initial treatment is the same: surgical debridement and antibiotics. For foot debridement, anatomic knowledge is mandatory because massive edema can lead to a compartment syndrome of the plantar side of the foot. In case of ischemia, aggressive revascularization procedures, endovascular, surgical, or a combination should be performed to create adequate blood supply to the foot. METHODS: In a retrospective analysis, 150 patients were reviewed. RESULTS: In this approach, a two-year limb-salvage rate is more than 81.1% with a two-year patency of 62%. A primary amputation should be considered in case of a pre-operative mobility grade 4 or 5 (wheelchair dependency and bedridden, not able to move around). CONCLUSIONS: With aggressive treatment with or without revascularisation procedures, limb salvage of >80% can be achieved in the infected diabetic foot.