A Study to evaluate Clinico-pathology and management of diabetic foot

Abstract

Objective: The aim of the study bacteriology in diabetic wound, the pathophysiology of diabetic wound, various wound salvage procedures and outcome of different treatment modalities and newer techniques wherever applicable to prevent complications and to minimise the progression of occurred complication. Methods: The 100 patients admitted with diabetic foot in the department of Surgery, SBKS MIRC, Pipariya Vadodara (Gujrat) prospectively studied from July 2014 to Jan 2015. Patients with diabetes mellitus presenting with wound i.e. ulcer, blister, abscess, gangrene were included in our study. Patients with chronic wound due to cause other than diabetes such as traumatic, arterial, venous, trophic, TB, Syphilitic, malignant ulcer were excluded from study. Results: Highest number of cases was found in 51 – 60 years of age (34%) followed by 61 – 70 years of age (26%). 78 (78%) cases were male and 22 (22%) cases were female. Most of case had history of trauma 62%. As per Wegner’s classification of the diabetic foot 44 cases presented with grade 2 lesion, 32 cases grade 4 lesion, 18 cases grade 3 lesion, 4 cases grade 1 lesion, 2 cases, grade 5 lesion. Most of lesion (50%) are found in lower limb in which 40 cases presented with ulcer, 28 cases with gangrene of toe or limb, 16 cases with cellulitis, 4 cases with abscess and 12 cases with osteomyelitis. Most common isolated organism was s. aureus (36) followed by pseudomonas (20). The average hospitalisation in graded 2,3,4,5 lesion around 32 days .About 10% case required amputation while 56% cases managed only by daily dressing & slough excision. Among the complicated diabetic foot 12 patients developed osteomyelitis. All these patients had lesion of grade 3 and out of these 12 patients, 2 patients required AKA, 8 patients BKA, 5 patients had disarticulation from metatarsophalangeal joint. Conclusion : Diabetes affects all age groups, mainly manifest in middle part of life. Males are more affected than females. Neuropathy, ischemia along with immunological disturbance is important predisposing factor in pathophysiology. However both aerobic & anaerobic pathogens involve in diabetic wound infection but among them aerobic (mostly s. aureus ) is more common. Commonest presenting lesions in foot were ulcer, followed by cellulitis and gangrene. In the management of DFU the first requirement is strict control of diabetes, & early detection and treatment of lesions and regular foot care is also important.