Management of the Diabetic Foot: Surgical and Organisational Aspects

Abstract

Most patients are older, but increasing numbers of young patients also develop diabetic foot ulcer (DFU) [1]. A third of the patients are under 50 years of age [2]. The prevalence in the Western countries is 4-10 % and the incidence 2-6 % [3]. Only 10-60 % of patients are healed after the first three months [4] and the recurrence rate is 44 %, 61 % and 70 % after one, two and three years, respectively [5]. DFU results in extensive treatment costs, and the hospital treatment cost of DFU counts towards 25-30 % of the total hospital expenses of treatment of patients suffering of diabetes [6].

Recent progress in the treatment of patients with DFU has reduced the number of low-extremity amputation (LEA) cases. These improvements have been achieved through an increasing understanding of the importance of the multifactorial background of DFU, and that there should be a multidisciplinary organ„ised structure behind the treatment of DFU. This used to be a topic of interest, but especially focused on in the International Consensus on the Diabetic Foot from 1999 [3]. Our understanding of the importance of surgery in DFU has increased over the last 30 years [7 17]. A simple classification based on presents or absents of neuropathy, open wound or infection has been suggested [16]. Treatment is dependable of the type and classification group of the wound. Various surgical correction techniques are available [18] [19].

The team approach and collaboration between all healthcare professionals is required to facilitate good quality holistic care [20 23]. Recognition of the talent and creativity of all employees in the multidisciplinary team will increase the chance of success in establishment of the concept [24].

This article is based on a presentation focusing on the surgical and organisational aspects in the treatment of DFU.

Key words

Diabetic foot - Surgery - Organisation - Wound centres - Multidisciplinary collaboration

References

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