http://austinpublishinggroup.com/foot-ankle-studies/
Ulcerationsof the foot in diabetic patients are common, disabling and predispose to
ascending infections such as gangrene and sepsis which frequently necessitate
amputation of all or part of the lower extremity. Effective treatment of
Diabetic Foot Ulcers (DFU) can have a major therapeutic benefit resulting in
reduced morbidity, mortality and the need for surgical intervention. We review
the major factors contributing to the development of these lesions and the
components of an effective multidisciplinary approach to treatment with the
goal of limiting major surgical intervention such as amputation when possible.
Lowerextremity ulceration in diabetic individuals is common, with a lifetime risk estimated
at between 12-25%. Presence of a DFU results in substantial patient morbidity,
impairment of the quality of life, and ultimately in higher treatment costs
estimated at tens-of-thousands of dollars per lesion. Up to 85% of lower
extremity amputations in diabetic individuals may be preceded by skin
ulceration emphasizing the need for effective preventative and therapeutic
strategies in dealing with these lesions.
Theetiology of DFU is usually multi-factorial with a combination of factors
coalescing to result in the clinical lesion. Of the multiple etiologic factors
summarized in, the presence of neuropathy is considered the most significant.
Diabetes induced peripheral neuropathy results in the loss of the protective
sensation of pain, while autonomic dysfunction and sympathetic denervation
result in dry skin and a warm foot. Additional contributing factors may include
the presence of peripheral vascular disease, callus formation, edema and
deformity. These combined factors result in tissue-damaging mechanical loads
applied to an insensate and poorly perfused foot which is unable to sense and
prevent the impending ulceration, and impedes the tissue’s ability torepair the
resulting damage and defend against subsequent infection.
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