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PLASTIC SURGERY OF THE DIABETIC FOOT

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comprehensive presentation of the role of plastic surgery in the management of diabetic foot . the role of plastic surgery is to avoid the amputation of the limb which was the classical treatment of infection and gangrene of the foot. plan of treatment and examples of reconstruction the foot. Cooperation with diabetologists , vascular and general surgeons is a must.

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PLASTIC SURGERY OF THE DIABETIC FOOT

  1. 1. Plastic Surgery of the diabetic foot a new challenge for the reconstructive microsurgeon Dr. Hussein S. Abulhassan Professor of Plastic Surgery Alexandria University
  2. 2.  Plastic surgeons have been recently involved in the care of a new group of patients’ population who were before facing the ultimate fate of below or above the knee limb amputation.  This new group of patients are the results of the excellent work of the general and vascular surgeons along with the refined work of diabetologists.  It was estimated that out of all limb amputations performed in USA 50 % were in diabetic population.
  3. 3. New understanding of the pathophysiology of diabetes in the foot and lower extremity has enabled the vascular surgeons and the plastic surgeons to attack these hopeless cases and perform bypass procedures like femorotibial or femeropedal anastomoses.
  4. 4. Pathophysiology of diabetic ulceration  In addition to the metabolic consequences of diabetes and the problems of the wound healing and increased suscibtibility to infections.  The pathophysiology of diabetic foot ulcveration can be divided into 4 major areas: Peripheral neuropathy Peripheral vascular disease Haemorreologic abnormalities Immune system impairment
  5. 5. Peripheral neuropathy Involvement of autonomic N.S. Involvement of sensory nerves of the foot. Involvement of motor nerves of small muscles of the foot. Charcot’s bony changes.
  6. 6. Aetiology of peripheral ulceropathy Complex. Autoimmune mechanism and microvascular mechanism. Segmental demyelination. Role of double crush phenomenon.
  7. 7. Tarsal Tunnel Compression
  8. 8. Loss of ability to feel pain or pressure Abnormal pressure points of the foot Anhydrosis, hyperkeratosis, callus formation over insesate areas Hemorrhage Fissures Bacterial Localisation Infection Ulcer formation  Hyperglycemia  Low immune modualtion  Poor vision
  9. 9. Vascular Disease  Two misconceptions in diabetic foot: 1. Foot problems are due to small-vessel disease. 2. Ischemic ulcers can occur in the presence of normal pedal pulse.
  10. 10. Hemorheology Alterations in blood flow 2ry to serum viscosity and decreased RBCs deformability. Platelet aggregations, RBC aggregations and increased fibrinogen levels.
  11. 11. Immune Deficiency Polymorphonuclear cell dysfunction. Opsonization. T-cell response, phagocytosis.
  12. 12. Management Preoperative evaluation Revascularization versus amputation. Wound management.
  13. 13. Soft tissue reconstruction Management of weight bearing areas of foot. Metatarsal heads I- Weight Bearing Areas
  14. 14. Levels of foot amputations
  15. 15. Levels of toe amputations
  16. 16. Soft tissue reconstruction Management of weight bearing areas of foot. The heel defects
  17. 17. II- Non-weight Bearing Areas A. Forefoot B. Instep region C. Achilis region.
  18. 18. Adjuvant plastic surgery procedures Vascular reconstruction. Tarsal tunnel release. Bone management. Tendon arrangement.
  19. 19. The Future
  • akashaamber

    Mar. 31, 2021

comprehensive presentation of the role of plastic surgery in the management of diabetic foot . the role of plastic surgery is to avoid the amputation of the limb which was the classical treatment of infection and gangrene of the foot. plan of treatment and examples of reconstruction the foot. Cooperation with diabetologists , vascular and general surgeons is a must.

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