Minor Amputations and Prophylactic Surgery in Diabetic...
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Minor Amputations and Prophylactic Surgery in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen Wound Healing Center Bispebjerg University Hospital, Denmark [email protected]
Transcript of Minor Amputations and Prophylactic Surgery in Diabetic...
Minor Amputations andProphylactic Surgeryin Diabetic Feet
Klaus Kirketerp-Møller, Consultant, Ph.d. stud
Copenhagen Wound Healing Center
Bispebjerg University Hospital, Denmark
Toe Amputations
• Indications
• Infection in IP joints
• Osteomyelitis
• Non-healing ulcer is NOT an
indication
• Gangrene with restored
perfusion
• Localized gangrene (emboli)
• Deformities in lesser toes
Exarticulations
•Never in IP joints
•Remove cartilage in MTP
joints
•=Transmetatarsal
amputation
Joint Resection
•MTP Joints
• Infection
• Infection control
•Off-loading
•Plantar approach
•Resect cartilage on proximal
phalanx
Transmetatarsal amputations
•Single rays
• From medial side
- Up to two
• From lateral side
- Up to three
•Forefoot amputation
Chopard amputation
•Short stump
•High pressure
•Rotational forces
Symes Amputation
•Shortening
•High Pressure
•Rotational forces
•Fat pad displacement
Tissue Defects
• Definition of a diabetic foot ulcer:
• ”A defect of the skin on a foot in a person with diabetes”
• The ”beginning”
• The ”end”
How Long to Heal a Diabetic Foot Ulcer?
• ”How long is a reasonable time?”
• 3 weeks!
One Week Later
Tenotomy Results
Consider Tenotomy
•Ulcer at pulpa
•Ulcer at dorsal PIP
•Nail changes
•Callus formation at tip of
toes
•Be aware of transfer
pressure
Achilles Tendon Lengthening
•High healing rates of
forefoot ulcers (91%)
•Transfer ulcers at heel
(15%)
•This lead to a pause in using
this procedure
• It is re-introduced due to a
change of procedure (from
percutaneous to open
technique)
Further Reading
The Diabetic Foot Triad
• “…with reported recurrence rates between 30% and 40% in the first
year.”
Guidance on footwear and offloading, IWGDF 2015
Prophylaxis
•Primary
• Diabetes Care
• Screening for Neuropathy
• Screening for PAD
• Training
• Regular Podiatry
• Appropriate foot wear
•Secondary
• Appropriate foot wear
• Training
• Regular podiatry
• Diabetes Care
Wound Closure
• Primary Healing
• Healing by secundary intention
• Conservative
• Augmented
- NPWT
- Growth factors
- Artificial skin
• Tissue Transfer
• Split skin transplant
• Local flap
• Free flap
Titel/beskrivelse (Sidehoved/fod)
Wound Closure
• Primary Healing
• Healing by secundary intention
• Conservative
• Augmented
- NPWT
- Growth factors
- Artificial skin
• Tissue Transfer
• Split skin transplant
• Local flap
• Free flap
Wound Closure
• Primary Healing
• Healing by secundary intention
• Conservative
• Augmented
- NPWT
- Growth factors
- Artificial skin
• Tissue Transfer
• Split skin transplant
• Local flap
• Free flapInvolves a plastic surgeon
Flaps
• Why not flaps?
• Tradition
• Arteriosclerosis
• Patency
• Durability
Thank You for Your Attention
How I work
85 %
Thank you for your attention.
Navn (Sidehoved/fod)
