DIABETIC FOOT;

Abstract

Objective: Diabetic foot is one of challenging diseases based on uncontrolled diabetes mellitus. The aim of this study was toevaluate the surgical management in diabetic foot patients presenting with different grades of infection. Design: Descriptive study. Place andduration of study: Surgical unit I, Department of Surgery at Nishtar Hospital Multan for a periods of two years from January 2009 to December2010. Patients and methods: A total of 120 diabetic patients with different severity of foot infections who presented in causality and surgicaloutpatient department Nishtar Hospital Multan, where included in this study. Patients included in this study were above age of twelve years andwere of both sexes. A detailed history was taken followed by the clinical examination. Routine investigations including complete bloodexaminations, complete urine examination, renal parameters, X-ray foot, CXR, ECG and pus for culture and sensitivity were recorded. Lesionswere raded according to Wagner classification and appropriate medical and surgical treatment carried out. Results: This study was carried outon 120 diabetic patients, out of which ninety six (80.0%) were male and twenty four (20%) were female. Male to female ratio was 4:1. Majority ofthe patients (n=66) were between the age group of 50 to 60 years. In majority of these patients forefront was involved, mostly big or little toe,.Patients were grouped into five grades according to the severity of infection. Twenty six (21.6%) patients were managed with antibiotics anddressings, thirteen (10.8%) patients needed debridement and skin grafting while eighty-one needed amputations of different types.Staphylococcus aureus was the commonest organism isolated. Conclusions: Majority of the diabetic foot lesions were in grade II to V. Lessergrade lesions responded well to conservative management with antibiotics, dressings and debridement. While those with higher grades neededamputations. Basic principles of management include early detection of diabetic foot, proper control of infection, control of diabetes mellitus andwound care. Delayed and improper treatment leads to osteomyelitis resulting in amputation and permanent disability of deformity