Which is the principle for management of diabetic foot?
Ans: a. (Control of DM)Ref: Cuschieri, 4th ed. pg. 783The treatment of diabetic foot should be multi disciplinary involving vascular surgeon, diabetologist, and chiropodist. The main pathophysiology of diabetic foot involves a combination of neuropathy, infection and ischaemia. The goal of management should be control of blood glucose and health education directed at preventing foot trauma.Prolonged antibiotic therapy should be used in the event of osteomyelitis. Prompt surgical drainage of abscesses should be undertaken.In summary, the treatment of diabetic foot should involve:1. Adequate control of blood glucose2. Prompt control of sepsis3. Vascular assessment4. Debridement including minor amputations. Major amputations should be undertaken for severe spreading uncontrollable limb infection threatening life, or the limb is severely ischaemic. Once one limb has been amputated, there is increased risk of amputation of the other limb, and the patient's survival rate is only 30%. Topical antibiotics are not of much benefit in the management of diabetic foot.Though both options, a and c are correct, option a (control of diabetes) seems to be the better answer.
Control of DM
Topical antibiotics is paramount
Protection of the other limb
Early amputation
Wounds, Tissue Repair & Scars