LSDF 36 Surgical Management of the Infected Diabetic Foot скачать в хорошем качестве

LSDF 36 Surgical Management of the Infected Diabetic Foot

#DiabeticFootInfection #SurgicalManagement #LimbSalvage #Amputation #Osteomyelitis #NecrotizingFasciitis #DiabeticFootCare #WoundCare This video, drawing from "Limb Salvage of the Diabetic Foot - An Interdisciplinary Approach", discusses the surgical management of infected diabetic feet, a challenging issue with significant medical and economic impact. Infections are difficult in diabetics due to impaired immune response (polymorphonuclear leukocytes don't travel, engulf, or kill bacteria effectively, worsened by high blood sugar), neuropathy (muffled alarm system, delayed detection), peripheral arterial disease (poor blood flow affecting immune cell delivery and healing), and reduced local inflammation. Key statistics are sobering: 15% lifetime risk of a foot ulcer, 40-80% of ulcers get infected, 15% develop osteomyelitis, and 15% ultimately lead to amputation. People with diabetes account for over half of non-traumatic lower limb amputations. Post-amputation 5-year survival is tragically low, around 40%. Infections are surgically classified into skin/soft tissue (mild to moderate), bony (osteomyelitis), and limb/life-threatening emergencies. *Surgical Approaches:* *Skin & Soft Tissue Infections (Ulcers, Cellulitis):* Often start subtly due to neuropathy. Diagnosis looks for pus, spreading redness, warmth. Imaging assesses depth. Emphasises surgical debridement to remove non-viable/infected tissue, reduce bacterial load, and expose healthy tissue. Wounds are usually left open to heal by secondary intention. Crucially, obtain deep tissue samples (curettage, biopsy) for culture; superficial swabs mislead. Infections are typically polymicrobial (3-5 species) including anaerobes. *Abscesses:* Deeper collections of pus, tricky in diabetics due to subtle signs. Can cause systemic illness. Imaging (MRI/ultrasound) needed for diagnosis. Management requires timely incision and drainage to evacuate pus, debride tissue, and remove the abscess wall. Broad-spectrum antibiotics are started empirically. *Osteomyelitis (Bone Infection):* Destructive, present in up to 60% of infected ulcers. Aggressive surgery is needed. Vascular status is paramount; revascularisation may be required first. Infection spreads from soft tissue to bone. Bacteria form biofilms and hide, resisting treatment. Diagnosis uses probe-to-bone test (specific but not sensitive), elevated ESR/CRP (white count may be normal), and especially MRI. Gold standard is often bone biopsy for culture. Management is multidisciplinary: good blood flow, tailored antibiotics, and early, radical surgical debridement ('oncologic approach') to eradicate all infected bone/tissue. The resulting defect is managed with beads/spacers or packing. Reconstruction follows confirmed infection eradication. *Surgical Emergencies (Gas Gangrene, Necrotizing Fasciitis):* Rapidly progressing, life-threatening. High mortality (20-80%). Priority is patient life over limb. Often polymicrobial. Warning signs: systemic illness, rapid skin changes, swelling, sometimes crepitus (gas often absent initially). Emergent imaging (CT) is vital. Management: immediate broad IV antibiotics and radical debridement. The decision between limb salvage (multiple surgeries, risk) and primary amputation (potential reduced morbidity but huge psychological impact) is difficult but necessary. Debridement must happen before revascularisation. Poor prognostic signs for salvage include multiple necrotic toes or heel involvement. The surgical approach involves a complex balance: radical debridement is essential to eradicate infection, while preserving enough viable tissue for function. Amputation must be considered when infection severity outweighs the chance of salvaging a functional foot.