dranupdhir@hotmail.com 
India has more number of people with diabetes than any other country apart from China. This is conservatively estimated to be 77 million adults and approximately 1 in 4 will experience a foot ulcer at some point. This figure is important because it is important to realize that foot ulcers result in the loss of a limb. The number one cause of a wound that becomes and amputation is delayed treatment.
This page describes what you have, and what treatment options are available, if a wound on your foot doesn't heal after 2 weeks, or if you or someone you care for has a wound on your foot.
A foot ulcer is an open wound on the foot that doesn't heal as it should. Foot ulcers are typically caused by friction, pressure or vascular disease in persons without diabetes. Diabetics have three issues that make even minor injuries a problem: decreased immune function, PAD (Peripheral Artery Disease), and peripheral neuropathy (nerve damage).
Neuropathy takes away the warning. If a person has diabetic neuropathy, he/she might walk on a blister, small cut, or a stone bruise for days without experiencing any pain. When the wound is discovered, it is most likely already infected.
When the blood flow is poor, it slows everything down. There is a slow influx towards the wound of oxygen and nutrients. The cells that fight infection are late in arriving. Weakness of the tissue around the wound is already in place and antibiotics alone do not usually heal a diabetic foot ulcer.
The most common classification system for DFUs is the Wagner Classification which is used to direct the treatment of the DFUs.
If this infection is not managed, it may only take a few days to progress from Grade 2 to Grade 3. This is why it is important that a foot wound in a diabetic is seen by a specialist within 48 hours of discovery, rather than at the next routine check-up!
It takes several different specialists to care for the diabetic foot. Blood sugar is managed by a diabetologist. A vascular surgeon evaluates and restores blood flow, if possible. Reconstruction and closure of wounds is done by a plastic surgeon.
A plastic surgeon becomes essential when:
Debridement is very often the initial surgical procedure. All dead bone, infection and necrotic material is excised. No antibiotic or dressings can stop the growth of dead tissue in the wound, which cannot heal.
Skin grafting is effective for wounds where the wound bed is clean, and the blood supply is good. The skin is pulled from the thigh and grafted over the wound. The most common use of split thickness grafts is for foot ulcers.
When the wound is deep, or when there is exposure of bone or tendon, or the blood supply is inadequate to support a graft, flap reconstruction is used. A flap provides skin and soft tissue with its own blood vessels and blood supply, and offers long-lasting coverage that a graft will not.
Negative pressure wound therapy (NPWT or vacuum-assisted closure) is used to drain fluids, decrease bacterial population, and prepare the wound bed for grafting or flap coverage between debridement and final closure.
In most cases, diabetes patients' amputations can be avoided. They occur when wounds are not recognized until they are quite old, they are not treated properly, or when the blood sugar level is not controlled well enough for the wound to heal even when it is treated.
There are three factors which can help prevent the amputations of diabetics more effectively than anything else:
Dr. Anup Dhir is a Senior Consultant with Plastic and Reconstructive Surgery at Apollo Hospital, Indraprastha, New Delhi with 40 years of experience in reconstructive surgery, skin grafting and flap surgery for complex wounds.
If the ulceration is deep, not improved after two weeks or if bone can be seen or probed, a plastic surgery consultation for foot ulcer is the best option for the Delhi. The longer you wait, the tougher it will become to treat every grade of wound.
Leave a request to connect to Dr. Anup Dhir for an Appointment.