Abstract
This article systematically evaluates the most used diagnostic measures for the management of diabetic foot in the elderly, the decision making in the surgical approach, the tertiary prevention of the disease and the microbiological behavior. The initial diagnostic study for musculoskeletal infections and alterations is conventional radiography (sensitivity 40-75%, specificity 60-90%), computed tomography is more useful in the approach to chronic infection, assessing bone abductions and deformities. Magnetic resonance (sensitivity 100%, specificity 40%) is useful to assess the formation of abscesses and bone compromises.Decision-making in the surgical approach is due to sensory, motor or mixed neuropathy; which predispose to ulcers, fractures, deformities and fissures of the skin; lesions that are overinfected and must be operated on. Infections in elderly people with diabetic foot show that Staphylococcus Aureus is the main pathogen causing osteomyelitis. Beta-hemolytic Streptococci / S. Aureus, in patients with cellulitis, without open cutaneous wound, except in repeated mono microbial cultures, immunosuppressed patients or ulcers that do not respond to treatments. The diagnosis and treatment of diabetic foot continues to be a challenge for the health system; it is important that health institutions form interdisciplinary groups aimed at improving patient conditions, who must perform timely, adequate treatment, with routine monitoring and follow-up; using diagnostic methods throughout the course of the disease in order to reduce the need for amputations of the extremities.Keywords: Therapeutic approach, Diabetic Foot, osteomyelitis.
Highlights
Decision-making in the surgical approach is due to sensory, motor or mixed neuropathy; which predispose to ulcers, fractures, deformities and fissures of the skin; lesions that are overinfected and must be operated on
The diagnosis and treatment of diabetic foot continues to be a challenge for the health system; it is important that health institutions form interdisciplinary groups aimed at improving patient conditions, who must perform
Diabetes mellitus (DM), is nowadays understood as a set of diseases characterized by chronic hyperglycemia, resulting from defects in insulin secretion, insulin action or both, and in other cases multihormonal defects as a cause of epigenetic effects (DNA methylation, histone modification, and microRNAs) [1]
Summary
Diabetes mellitus (DM), is nowadays understood as a set of diseases characterized by chronic hyperglycemia, resulting from defects in insulin secretion, insulin action or both, and in other cases multihormonal defects as a cause of epigenetic effects (DNA methylation, histone modification, and microRNAs) [1]. Despite this; Recurrence is very common, reaching 40% in the first year, 60% at 3 years and up to 65% in the first 5 years Determining these changes early generates a significant impact factor in reducing the development of ulcers and the risk of amputation. To develop early diagnosis measures in addition to a clinical history focused on the patient with diabetic complications, causes a more cost-effective intervention impact by reducing the number of recurrences in the development of ulcers and improves the effect of adherence to the integral treatment of these patients and their inclusion in activities of daily life. In the systematic search of the literature, there are no publications that show what are the diagnostic and therapeutic characteristics that lead to the decision making of specialists in the therapeutic approach of these patients; likewise, neither the surgical characteristics that determines the management for the short and long term control of diabetic foot complications. It evaluates what is the microbiological behavior in this disease and the decision making in the surgical approach in the tertiary prevention of the disease
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