Abstract
Diabetic foot (DF) involves a neurogenic ulcer and wet necrosis. DF tends to be accompanied by infection. It is important to establish strict glycemic control and perform infection control by adequate administration of an appropriate antibiotic drug. We also evaluate the ischemic factor based on skin perfusion pressure (SPP) in all cases. When wound healing is delayed, and the pulse of the dorsalis pedis artery and posterior tibial artery can not be palpated, we perform an angiographic examination. In cases demonstrating deep infection, we open the wound and reduce the necrotic tissue in the wound as local treatment. When there are signs of vascular stenosis and obstruction, we perform thorough debridement after revascularization. As adjuvant therapy, we make full use of negative pressure wound therapy (NPWT) pre/postoperation for wound bed preparation. Furthermore, we promote hyperplasty of the granulation tissue using basic fibroblast growth factor (bFGF). In the case of suture, we reduce the number of dermostitches and subcutaneous sutures. A very thin split thickness skin graft technique is performed to cover the raw surface.
The treatment of DF is not merely confined to local treatment. We perform multidisciplinary treatment from a total viewpoint and careful treatment is necessary.
