Corrective Surgery For Diabetic Foot
Corn And Callus Removal
Medicated lotion can be used to remove small corn and callus and also for prevention. If the corn and callus are large then surgical excision can be done. The wound can be left open to heal by itself or sutures can be taken for primary healing
Debridement
Debridement is the removal of dead, devitalised, contaminated or foreign material from, within or adjacent to a wound, till surrounding healthy tissue is exposed and it is widely used in Diabetic foot care. In diabetic foot ulcers, if dead tissue is present in the surrounding the ulcer never heals. Even the vicious cycle of uncontrolled glycemic reports and increasing infection will not allow healing to happen. We need to attack this cycle so that we can speed up the healing. For that all dead necrotic bones and soft tissues need to be excised. So that wound becomes ready for coverage. Some times after debridement the use of a technique called NPWT - negative pressure wound therapy will help to develop good granulation and healing tissue.
Angioplasty Or Vascular Bypass For Blood Vessels: It is known that the blood vessels in diabetics also are affected by high sugar levels. Due to hyperglycemia there is atherosclerosis which blocks the vessels and causes ischemia. They have diabetic microangiopathies as a common symptom, but many of them have major vessels problems also. This in turn will prevent good blood supply to the ulcer area. Due to reduced blood supply the tissue oxygen supply and fighting against infection also reduce.CT angiography is the standard test to find out condition and blockage of blood vessels.
Angioplasty is a procedure to restore blood flow through the artery. So by using angioplasty one can remove the block and revert some of the ischemic pathology.angioplasty is a minimally invasive procedure while the block is major a vascular bypass is required. This will improve distal blood supply and will help the tissue healing in foot ulcers. This is done by vascular surgeons.
Wound Coverage
Wound coverage is necessary to cover the chronic non healing ulcer. Until the wound is covered with healthy tissue, it may cause repeated infection. There are various surgeries like skin graft and flaps are available in plastic surgery for wound coverage.Plastic surgeons are the best doctors for diabetic foot treatments. Various plastic surgical techniques can be combined also to make the patient walk on his foot.
Surgical Offloading
One of the major causes of foot ulcer in diabetes is the presence of abnormal pressure on the part. In routine medical practise special shoes or footwear are given to patients for prevention of the pressure at the ulcer sites. we in india do not wear footwear in home, kitchen and our temples. Even the look of such foot wear is not cosmetically appealing to wear in any social function. It is difficult for these elderly people to wear these footwear without help from someone. Finally patients are not 100%compliant to these pressure offloading shoes.
As described earlier the ulcer formation is the end result of changed biomechanics of the foot. The association between the biomechanics and ulcer formation for common ulcer sites is found. Depending on that principle , various plastic surgical procedures are created. This will internally support and offload the foot at the site of ulcer. So ulcer heals without major intervention and remains healed for a long time.
Various tendon transfer procedures, various bony modifications can be done to restructure the foot. Though the foot cannot be normal as before but the specific ulcer point pressure reduces a lot allows the ulcer healing.
Keller’s arthroplasty, Modified Jones procedure, Girdlestone procedure, Flexor tenotomy, extensor release, gastrocsoleus recession, tendo achilles reconstruction and sliding osteotomy are few of the common plastic surgical procedures done for ulcer healing in diabetic foot.Dr Ashutosh Shah has been trained in all these procedures.
The main advantage of surgical off loading procedures is it will heal your ulcer and keep it healed without significant recurrence. You don't need to wear cumbersome footwear for 24 hours. The tissues that are supported from within will need lesser support outside.
Joint Fusion & Orthopedic Surgery
Most of the diabetic patients visit doctor when the ulcer progresses to a significant damage to surrounding tissues.The non plastic surgical speciality doctors use routine surgical methods and try to heal the ulcer,but the patient once walk on the foot after ulcer healing the same faulty biomechanics starts playing and ulcer recurs.In this whole process some times deeper infections, osteomyelitis, bone loss can happen. This will make it difficult to reconstruct the normal biomechanics even with surgeries, in such cases the joint fusion is the option to save the limb.
Charcot’s arthropathy is a midfoot collapse in diabetic patients. If the patients come in early stage the bony procedure can help them to prevent collapse.this will help to heal your midfoot ulcer. The orthopedic doctors will perform bony reconstructive surgeries
Nerve release
Some times the nerves in diabetic patients get swollen due to inflamation. Where the nerve passes through thin tunnels in their course, the tunnel will cause compression on nerve and its function is affected.if the tinel’s sign is positive then release of nerve tunnel may improve nerve function. It can improve sensory and motor neuropathies to some extnt . it also can improve in continuous tingling or burning sensations in foot.this nerve release are performed by a plastic surg