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What is Diabetic Foot Ulcer Surgery?

Diabetic foot ulcer surgery is a procedure in which a vascular surgeon removes the infected tissues. At times, when the ulcers are severe, the surgeon recommends diabetic foot ulcer treatments such as debridement and reconstruction surgery for effective results. 

USFDA-Approved Procedure

USFDA-Approved Procedure

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Best Doctors For Diabetic Foot Ulcers

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      Best Vascular Clinic for Diabetic Foot Ulcer Surgery

      Best Vascular Clinic for Diabetic Foot Ulcer Surgery

      At Pristyn Care, we make sure that every person who needs advanced diabetic foot ulcer treatment in India gets optimal care. We leverage modern technology and treat patients with compassion to understand and resolve their problems. 

      Our vascular surgeons are upskilled in performing advanced diabetic foot ulcer treatments and have an average experience of 10-13 years. They offer effective and comprehensive diabetic foot ulcer treatments.

      What happens if diabetic foot ulcers are left untreated?

      What happens if diabetic foot ulcers are left untreated?

      In case you don’t seek treatment for a diabetic foot ulcer in time, you will have to face the following complications:

      • Skin and bone infections may occur due to severe nerve and blood vessel damage. 
      • Abscess also occurs due to infection in the ulcer which will create a pocket filled with pus or blood. 
      • Gangrene occurs when the blood vessels are damaged, and the blood flow to the area is cut off. The tissues in the affected area will start dying. 
      • Deformities are another complication of leaving the foot ulcer untreated as it will weaken the muscles in the feet and lead to problems like hammertoes, prominent metatarsal heads, pes cavus, claw feet, etc., halting your ability to walk. 
      • Charcot’s foot is another complication that often occurs in diabetic patients. The bones become so weak that they can break, and the nerve damage around the area lessens the sensation, thereby preventing from realizing this problem. As a result, you continue walking on the broken bones, and the foot shape will start to change. 
      • Amputation is the last thing that might need to be done if you leave diabetic foot ulcers untreated. When the site is infected, and the tissues continue to die off, there is a higher risk that the same thing will happen to other body parts. As a result, the surgeon will have to amputate the foot to prevent the infection from spreading. 

      What are the different types of treatments for diabetic foot ulcers?

      What are the different types of treatments for diabetic foot ulcers?

      When the foot ulcer cannot be treated using non-surgical methods, the following are different methods the vascular surgeon will consider for the treatment-

      1. Debridement- It is a procedure that involves the removal of the hyperkeratotic tissue, fibrin, biofilm, and necrotic tissue from the ulcer wound to facilitate healing. With this technique, the wound healing process can be initiated by the small vessels that transport fresh blood to the edges of the debrided wound. 

      2. Reconstructive Foot & Ankle Surgery- This method needs expertise and is performed by a Vascular surgeon precisely to reconstruct the affected area. It involves a thorough musculoskeletal examination, plain radiographs, CT scans, and MRI scans that help to determine the surgical plan. Following are different types of reconstruction techniques used by a vascular doctor for diabetic foot ulcer treatment-

      • Arthroplasty
      • Osteotomies
      • Resection 
      • Arthrodesis 
      • Tenotomies
      • Tendon transfer 
      • Tendon lengthening 

      The goal of the surgery is foot rebalancing and creating a plantigrade foot that can distribute the pressure in the leg. It is considered a type of internal surgical offloading. 

      3. Vascular Reconstruction- In case the blood vessels in the legs are extremely damaged and you have arterial lesions with intractable pain and gangrene, the doctor will have to consider vascular reconstruction for the treatment of diabetic foot ulcers. It involves using synthetic grafts or blood vessels that are taken from other areas of your body and using them to recreate the blood vessels that were damaged due to ulcers. It restores the blood flow in the wound and allows it to heal. 

      Diagnosis before diabetic foot ulcer surgery

      Diagnosis before diabetic foot ulcer surgery

      The doctor will inspect the foot, toes, and toenails for cuts, blisters, scratches, or ingrown toenails that can lead to the formation of foot ulcers. S/he may also ask you to stand and walk to analyze how the body weight is distributed across the bones and joints. The shape of the foot will also be checked as abnormal alignment of the foot can also increase the risk of ulcers. A vascular doctor may also recommend a few diagnostic tests to determine the best-suited treatment according to the severity of the condition. Some of the tests are- 

      • X-Ray- This imaging test is used to assess the alignment of the bones in the foot that contributes to the ulcer. The X-Ray will also help to determine the bone mass loss that happened due to diabetes. 
      • MRI Scans- The magnetic resonance imaging test creates a computerized 3-D image of the soft tissues inside the body. The doctor suggests this test to determine the extent of damage caused by the ulcer and also reveal if there is any inflammation present in the foot. 
      • Blood Test- It is recommended when there are signs of infection present with the ulcer. A blood test is done to screen for the infection. 

      Procedure of diabetic foot ulcer treatment

      Procedure of diabetic foot ulcer treatment

      During the surgery, the doctor will use spinal anesthesia to numb the lower half of your body. Once you are under anesthesia, you won’t be able to feel any kind of pain or discomfort during the procedure. There is a chance that you might be awake during the procedure and hear the machine running. To make sure that you don’t feel stressed during the surgery, the doctor may also give you anti-anxiety pills. 

      How to prepare for diabetic foot ulcer treatment?

      How to prepare for diabetic foot ulcer treatment?

      To prepare you for diabetic foot ulcer surgery, the doctor will give you clear instructions, including:

      • Stop medications like blood thinners before the surgery as they can increase the risk of excessive blood loss. 
      • Stop eating or drinking at least 8 hours prior to the surgery. 
      • 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. 

      What to expect after diabetic foot ulcer surgery?

      What to expect after diabetic foot ulcer surgery?

      After the surgery completes, you will most probably be asleep. You will be placed in the observation room until the anesthesia wears off. Afterward, you will be shifted to your ward. Depending on the procedure used for the treatment of diabetic foot ulcers, you may need to stay in the hospital for 24-72 hours. The doctor will closely monitor your condition after the surgery to make sure that there are no risks of complications. 

      Immediately after the surgery, you will feel numbness in the lower half of the body. Later, you may feel pain or discomfort for which the doctor will prescribe painkillers. The doctor will apply a splint to cover your foot and lower leg for proper support. 

      You will have to take complete bed rest for at least two days. After the doctor ensures that the wound is healing properly, you will be discharged. The doctor will also provide a detailed recovery plan to help you get back to your feet as soon as possible.

      FAQs about Diabetic Foot Ulcers

      How long does it take to recover from diabetic foot ulcer treatment?

      The recovery period after diabetic foot ulcer management depends on a variety of factors such as the severity of the wound, location, blood circulation, wound care, diabetes management, etc. The patient may take a few weeks to a few months to completely recover, depending on these conditions.

       

      What are the risks associated with diabetic foot ulcer surgery?

      Common complications associated with diabetic foot ulcer surgery are infection, hemorrhage, damage to the surrounding tissues, fever, arterial aneurysm, etc.

      Can a diabetic foot ulcer be treated at home?

      No. A diabetic foot ulcer cannot and should not be treated at home. In most cases, the ulcer becomes infected which further delays the healing process increasing the chances of infection. Removing the infection is not possible with home remedies. You should always consult a doctor for proper treatment of foot ulcers.

      Is it always important to take antibiotics for foot ulcer treatment?

      No. Treatment of diabetic foot ulcers using antibiotics won’t be required if the ulcer is not infected. In case mild soft tissue infection is present, it can be treated using oral antibiotics such as clindamycin, dicloxacillin, cephalexin, etc.

      Can I apply a cream to a diabetic foot ulcer?

      Yes. You can use certain creams or moisturizers to promote the healing of the diabetic ulcer. Doctors often advise patients on ointments that contain urea as it creates a barrier film over the wound and aids in healing. 

       

      What are the non-surgical treatments for diabetic foot ulcers?

      What are the non-surgical treatments for diabetic foot ulcers?

      The following are the non-surgical treatments for diabetic foot ulcers-

      1. Hyperbaric Oxygen Therapy- This treatment can be effective to a great extent in improving the healing of diabetic foot ulcers. A chamber is used where the patient lies on his/her back on a bed. The chamber is filled with 100% oxygen which increases the amount of oxygen in the bloodstream ten times. This speeds up the healing of the ulcer by stimulating the growth factors and stem cells. Sometimes, multiple sessions are done of this therapy to ensure that the wound heals properly. 
      2. Off-loading or TCC (Total Contact Casting)– It is another non-surgical treatment that involves relieving the pressure from the ulcerated area through an external means. Most commonly, the doctor will ask you to stay off your feet to prevent the infection in the ulcer from getting worse. To take the load off from your feet, the doctor will recommend wearing any of the following:
      • Shoes that are specially designed for people with diabetes 
      • Casts 
      • Foot braces
      • Compression wraps 
      • Shoe inserts 

      Case Study

      Case Study

      Mr. Vikram Sharma (changed name) approached Pristyn Care in January 2022. He complained of swelling in the legs, pus, discoloration of the skin, blood discharge, and an ulcer over the right heel. He was 62 years old and was diagnosed with a Grade 3 diabetic foot ulcer and was a patient of hypertension and heart disease. He also underwent CABG(Coronary Artery Bypass Grafting) in 2008, which was major surgery. 

      Our medical coordinator connected him with our vascular expert Dr. Sanjit Gogoi. He asked about his medical and family history of Mr. Sharma to assess the condition. He even conducted a physical examination to check the tenderness and the amount o fare that is affected due to a diabetic foot ulcer. Dr. Gogoi noted ankle swelling, edema, lipodermatosclerosis, hyperpigmentation of the limbs, and foul-smelling discharge.

      After a thorough examination, Dr. Gogoi concluded that Mr. Sharma is suffering from both diabetic foot ulcer and peripheral artery disease(PAD). The doctor then recommended debridement treatment to Mr. Sharma. During the treatment, an assistant cleaned the affected area with a solution, and later Dr. Gogoi removed the infected tissues precisely without harming blood vessels. Mr. Sharma stayed in the hospital for 3 days. He got discharged when the doctor ensured that the surgery was successful and Mr. Sharma was not showing any odd symptoms post-surgery. 

      Mr. Sharma took 3 follow-up consultations, recovered successfully, and informed that he can now move his foot without any pain or discomfort.

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