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Diabetic Foot Ulcer Surgery Procedure, Recovery & Complications

Diabetes can lead to various complications, and Diabetic foot is one such complication that is often observed in diabetic patients. Research says that approximately 15% of patients with diabetes develop this condition at some point. As the name suggests, this condition involves forming single or multiple ulcers, typically at the bottom of the foot. What makes these ulcers a cause of concern is their stubborn nature and the fact that they can not be managed through diet, exercise, or insulin.

Types Of Diabetic Foot Ulcers

Diabetic Foot Ulcers are broadly classified into three types:

  1. Neuropathic Ulcers: These ulcers affect patients with poor peripheral nervous system neurological function. The affected individuals develop pressure points that form ulcers in the epidermal and dermal tissue layers. This condition is commonly noted in the foot and rarely affects other body parts.
  1. Ischemic Ulcers: These ulcers commonly affect the feet and legs. Ischemic Ulcers are caused by poor blood flow in the legs. This inadequate blood flow damages tissues and causes the cells to die. The healing period of these ulcers is usually quite long.
  1. Neuroischemic Ulcers: These ulcers are common in patients with peripheral neuropathy and Ischemia i.e., restricted blood flow to any body part. They don't heal on their own and always require medical intervention. Infected Neuroischemic ulcers may require amputation.

When Should You See A Doctor For Your Diabetic Foot Ulcer?

Patients with this condition may experience various diabetic foot ulcer symptoms, including:

  • Pain and firmness in the wound
  • Formation of Eschar, a black tissue around the wound, due to lack of healthy blood flow
  • Swelling of the skin
  • Visible discoloration in the skin
  • Foul smelling discharge from the wound
  • Partial or complete gangrene
  • Thickened or callused skin

These symptoms may vary for each individual. In some cases, diabetic foot ulcers show little to no symptoms at all until the ulcer gets infected. Therefore, all diabetes patients need to consult a doctor if they notice any diabetic foot ulcer early signs.

Diagnosis

Self Diagnosis: Patients can diagnose foot ulcers by themselves. This condition becomes visible when the tissues surrounding the wound begin to die. In cases of peripheral neuropathy, patients experience reduced sensation in the feet and legs and do not notice the ulcer. Therefore, diabetes patients should inspect their feet daily to check for ulcers. Also, do not let injuries go unnoticed as they might turn into ulcers.

Diagnosis By Doctor:

If you notice signs of foot ulcers, You must immediately get in touch with a vascular specialist. He/she will perform a physical exam and analyze your medical history. The doctor will carefully inspect your foot, toes, and toenails to check for blisters, cuts, or ingrown toenails. All these conditions can develop into foot ulcers in the long run.

Abnormal alignment of the foot increases the risk of ulcers. So, the doctor will also check the shape of the foot. The doctor may also check your body weight distribution by asking you to walk.

Tests:

After analyzing your feet and collecting your medical history, the doctor may recommend some tests. These tests will help the vascular specialists get a clearer picture of the ulcers and understand their severity. The doctor may suggest the following tests based on his examination:

  1. X-Ray- An x-ray can help the vascular specialist assess the alignment of bones in the foot. Any misalignment, as discussed above, can contribute to the formation of ulcers. The X-ray will also allow the doctor to check for any mass loss caused due to diabetes.
  1. MRI Scans- MRI or magnetic resonance imaging tests provide a 3D image of the soft tissues inside the body. Doctors suggest this test to check for the damage caused by the ulcer and check for signs of inflammation in the foot.
  1. Blood Test- Ulcers are prone to developing serious infections. Blood tests help doctors check for signs of infection and its graveness.

Diabetic Foot Ulcer Treatment

When & Why Is Surgery Required?

When it comes to Diabetic foot ulcer treatment, the doctors usually begin by employing non-surgical methods. Early-stage diabetic foot ulcers can be managed without surgery. However, when these methods fail to produce the desired results, the doctor might suggest surgery to:

A) Remove the pressure on the affected region by shaving or excising the bone.

B) Treat infections by extracting the infected bone or other methods.

C) Correct leg deformities, including bony bumps, hammer toes, and more.

Types Of Surgeries

  1. Debridement

This surgical procedure involves the removal of dead or infected skin from the foot ulcer. Through this surgery, doctors get to examine the severity of soft tissue damage and ways to promote healing. In this technique, the surgeon will use small vessels to allow fresh blood to flow to the edges of the debrided wound.

  1. Reconstructive Foot & Ankle Surgery

Reconstructive foot surgery is performed to rebalance the foot and create a plantigrade foot. This is done in order to distribute the pressure in the leg. This method is quite complex and involves treatment through musculoskeletal examination, plain radiographs, CT scans, and MRI scans.

  1. Vascular Reconstruction

Several diabetic foot ulcers can damage the blood vessels in the legs and may cause arterial lesions with gangrene and exceptional pain. In such cases, the surgeons choose vascular reconstruction as a treatment for diabetic foot ulcers. In this method, the surgeons replace the damaged vein or artery with synthetic or tissue grafts. This allows blood flow in the wound and promotes healing.
 

Preoperative Preparation

Before the surgery for your diabetic foot ulcer, the doctor will give you some clear instructions that you must follow. These instructions might include:

  • Restricted consumption of food and fluids at least 8 hours before the surgery.
  • Do not take medicines like blood thinners before the surgery as they can increase the risk of excessive blood loss.
  • Do not take aspirin for at least one week before the surgery.
  • Do not shave the surgical site for at least 2 days before the surgery date.

These pre-operative preparations will help you have a smooth surgery experience.

Complications That Can Occur During Diabetic Foot Ulcer Surgery:

All the patients who are required to get surgical treatment for diabetic foot ulcer must be aware of the surgical complications associated with this treatment. Listed below are the risks and complications of foot ulcer surgery:

  1. Allergy To Anaesthesia: Anaesthetic agents can impact each individual differently. Since several people aren't aware of all of their allergies, it is likely for some to develop an allergic reaction to anesthesia. This allergy may cause itching on the body.
  1. Excessive Bleeding: The surgery will involve the removal of dead tissues. During the removal procedure, the doctor might also remove the blood vessels underneath. This process can cause the ulcer to bleed. In addition, large ulcers may also bleed profoundly during the treatment.
  1. Pulmonary Embolism: The ulcer can also develop blood clots. If they break down, they can travel to the lungs and cause pulmonary embolism, a condition in which a blood clot's arteries in the lungs become blocked. This is a life-threatening condition.
  1. Arrhythmia Or Heart Attack: In some cases, diabetic foot ulcer surgery may require dead tissue extraction. This can cause nervousness in patients and may even lead to arrhythmia.

Complications That Can Occur After Surgery for Diabetic Foot Ulcer:

The chances of developing complications persist even after surgery. Some complications that might occur after the surgery include:

  1. Damaged Blood Vessels Or Organs: The surgery for diabetic foot ulcers involves the extraction of dead tissues or infection. The blood vessels or healthy tissues may also get affected during this process.
  1. Infected Incision Site: As the healing time of ulcers is compromised, the risk of developing the infection again is quite high. Get in touch with your healthcare provider if the infection begins to reoccur.
  1. Burst Artery Or Aneurysm Rupture: There's a chance of burst in the arteries or an aneurysm in the weak blood vessel. However, this complication is quite rare.
  1. High Fever: Some patients may experience a high fever, chiefly due to the anaesthetic agents after surgery.

In case of the above-mentioned complications, contact your healthcare providers without delays.

Post-Surgery Care

Here are some easy ways in which you can take care of the wound after surgery:

  • Keep the wound or ulcer covered with dressings and topically-applied medicines as directed by the doctor. This will decrease your risk of infections.
  • Ensure adequate circulation in the area.
  • Keep your blood glucose level under control.

What Happens If You Leave Diabetic Foot Ulcers Untreated?

In some cases, patients fail to understand the graveness of diabetic foot ulcers and leave them untreated. Ulcers that are left untreated can cause serious complications, such as:

  1. Gangrene: Damaged blood vessels and lack of blood flow to the affected area can lead to Gangrene. In this condition, the tissues in the area gradually start to die.
  1. Skin & Bone Infections: Severe nerve and blood vessel damage can cause serious skin and bone infections.
  1. Abscess: Infections in the ulcer can lead to abscess i.e., a pocket filled with blood and pus.
  1. Deformity Of The Foot: An untreated foot ulcer can weaken the muscles in the feet and cause other medical conditions, including hammertoes, pes cavus, claw feet, prominent metatarsal heads, etc. These deformities can hamper your ability to walk and perform day-to-day tasks.
  1. Charcot’s Foot: This complication is quite common among patients with diabetes. In this condition, the bones become incredibly weak and risk breaking. Further, the loss of sensation caused by nerve damage in the area prevents the patient from identifying this damage. The patient keeps walking on broken bones, which causes the foot shape to change.
  1. Amputation: Amputation is needed when patients leave their diabetic foot ulcers untreated, and the site gets infected. The infection causes the tissues to die, and may affect other body parts. In such cases, surgeons prevent the infection from spreading by amputating the foot.

To avoid these complications associated with Diabetic foot ulcers, patients must seek immediate medical treatment and care.

Can Diabetic Foot Ulcers Be Prevented?

Research says that more than 50% of diabetic foot ulcers become infected and may lead to serious complications, including amputation. Therefore, preventive care is incredibly important. Here are some ways in which you can prevent developing Diabetic Foot Ulcers in the first place:

1) Keep Your Blood Glucose Levels Under Check: Closely monitor and maintain your blood glucose. Maintaining blood sugar levels decreases your chances of developing complications caused due to diabetes.

2) Maintain foot hygiene: Unhygienic feet are home to infections. Here are tips to keep your feet healthy and hygienic:

  • Keep toenails trimmed but not too short
  • Keep your feet dry and moisturized
  • Get corn and callus removed in time
  • Change your socks frequently
  • Get properly-fitting shoes
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