Surgical approach to the diabetic foot ulcer

SURGICAL APPROACH TO THE DIABETIC FOOT ULCER The discovery of and ability to manufacture insulin in 1922 drastically changed the prognosis of patients diagnosed with diabetes (1). This discovery turned a fatal, untreatable disease into a chronic, treatable disease, which has presented new and equally challenging health concerns in this unique patient population that include retinopathy, nephropathy, peripheral vascular disease, and peripheral neuropathy (2). Not only do these comorbidities pose significant challenges to the surgeon but also are becoming more and more prevalent as people live longer with the disease. The Centers for Disease Control and Prevention (CDC) estimates that 7.8% of the U.S. population, or 23.6 million people, have diabetes, and it estimates that another 57 million people in the United States have impaired fasting glucose level and are at significant risk of developing diabetes (3). This trend means there will be a greater percentage of the general population living with this disease with more foot wounds, infections, and amputations.