Complications related to Diabetic Foot include

Some complications require immediate attention and have serious ongoing effects on the foot which a Plastic surgeon should see and monitor closely.

These complications include:

• Infections and abscesses
• Foot deformity
• Wound or foot ulcers that do not heal
• Gangrene
• Charcot's Foot alters the shape of the feet as the bones in the toe and foot break or shift.

These complications can sometimes be reversed by a Plastic Surgeon such as infections but in some cases like Gangrene, it may lead to permanent physical change.

What are the different surgeries done for Diabetic foot?

1. Debridement - Debridement is the thorough cleaning of the wound and removing unhealthy infected and dead tissues from the wound. After debridement, Negative Pressure Wound Therapy (VAC) before the definite procedure is done to reduce the toxins and infection in the body.

After the wound area has settled, there may be a raw area, or defect, which needs to be covered either by skin grafting, local flaps, or free flaps (microsurgical reconstruction).

2. Fasciotomy – If the patient presents with rapidly increasing swelling, redness, or pain of the leg and foot, and even after antibiotic treatment it does not subside, it can lead to compartment syndrome (increased pressure in the muscle compartment). This is an emergency condition and urgent Fasciotomy is required to relieve the pressure otherwise it can lead to gangrene of the limb and severe sepsis in the whole body.

In this, we give incisions over the leg and foot such that pus, excess fluids, and toxins are drained without disturbing the blood supply of the limb. In cases of large and dirty wounds, debridement is done along with fasciotomy. The patient may require furthermore debridement to remove the unhealthy portion in the wound. After this, regular dressings are done daily.

After initial fasciotomy and debridement, Negative Pressure Wound Therapy (VAC) before the definite procedure is done to reduce the toxins and infection in the body. /

A definite Procedure to close the wound is done last which may be skin grafting, local or free flaps as per the requirement.

3. Skin grafting - Skin grafting is the transfer of a thin sheet of skin, usually taken from the thigh, to cover the raw areas of the leg and foot region. Once the wound is healthy, skin grafting may be done if the defect is not much deep and vital structures are embedded in granulation tissue. In such cases, dressing is done every alternate day after surgery. Patients may be discharged after 5-6 days, and regular follow-up is required. The area gradually heals and needs a compression garment later to avoid hypertrophy of scars and to reduce swelling.
4. Local Flaps - The local flap is the transfer of the flap of skin from the surrounding areas to the defect site. It is done when the defect is deep, and the surrounding area is normal and sufficient enough to cover the defect. If not, or the local flap fails, then a flap taken from other parts of the body is used to cover the defect through microvascular reconstruction.
5. Microvascular reconstruction - If the defect is deep and any vital structure is visible & exposed, like a blood vessel, nerve, bone, or tendons exposed, then the transfer of skin flap or muscle flap from a distant area as a free flap is done to cover the defect using microsurgical techniques. It needs surgical expertise and a good working team. Dr. Amit Agarwal specializes in diabetic foot microsurgical reconstruction and has saved innumerable feet and legs from amputation.

The flap should be monitored frequently post-surgery. Hospital stay is increased, concerning skin grafting or local flap procedures, but it is the best modality to cover the defects in diabetic foot patients. The dressing is done every alternate day and the patient is admitted for at least 7-8 days and discharged once the flap is settled.

The success rate of diabetic foot reconstruction is quite good around 80%- 90% in hands of Dr. Amit Agarwal. It means 80-90 out of 100 feet are saved from amputation. The results of microsurgical reconstruction in the diabetic foot can be quite unpredictable as it depends on multiple factors like the status of blood vessels, level of immunity of the patient, his/ her health status, and protein level to withstand the procedure.

All these surgical techniques are helpful at appropriate times, depending on the type of infection. Post-surgical management is equally important for the overall outcome of the treatment.

After the surgery, the patient is bedridden for 2-3 weeks. No ambulation is advised, and the limb has to be elevated by using pillows underneath. After several dressings, when the operated site is completely stable, the patient is given a pressure garment and ambulation is started.