Adhil Ahamed Yameen, K (2014) Reconstruction in revascularised diabetic foot. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Diabetes Mellitus is a disease with neurovascular and metabolic elements. These elements are related to each other. Changes in the metabolism of carbohydrate, proteins and lipids are secondary to absent or decreased secretion of insulin or due to ineffective action of insulin. Vascular syndrome is due to abnormalities in small vessels (microangiopathy). Neuropathic changes occur in peripheral nervous system due to metabolic and vascular causes. About 366 million persons were affected by Diabetes Mellitus in the year 2011 and this will increase to about 552 million by the year 2030. One of the most common cause of hospitalization in diabetics is due to foot infections. Foot lesions develop in 25% of this group during their period of life. One of the largest diabetic populations in the world is currently in India. Overall incidence of diabetes in India is 1.2 % of which incidence in urban population is 4 to 11% and incidence in rural population is 2.4%. Diabetes Mellitus Prevalence increases after the age of 40 years, 15 to 20% increase after the age of 65 years. MATERIALS AND METHODS: Type of Study: It is a retrospective clinical study. Study Setting: The study was conducted in the Department of Plastic and Reconstructive Surgery, Rajiv Gandhi Government General Hospital and Madras Medical College, Chennai over a period from January 2003 to February 2014. Sample Size: All the diabetic foot patients who got admitted and had undergone revascularization and subsequently had foot defects in need of reconstruction of foot or foot remnants from January 2003 to February 2014 were included in our study which includes 78 cases and it includes 10 females and 68 males. Inclusion Criteria: 1. All the diabetic foot patients who had undergone revascularization and had foot defects, subsequently in need of reconstruction of foot or foot remnants, 2. All revascularised diabetic foot patients with PT/ INR around 1.5. Exclusion Criteria: 1. Those who have undergone revascularization but with comorbid illness complicating anesthesia for foot reconstruction, 2. Patients with renal failure, 3. Age more than 70 years. RESULTS: Out of 78 patients included in the study, Maximum number of patients i.e., 34(43.58%) were in the age group between 56 to 60 years, 27(34.6%) were in the age group of 51 to 55 years, 10(12.82%) were in the age group of 45 to 50 years and the remaining 7 (8.97%) fall in the age group between 61 to 65 years. Mean age found in the study is 57.2 years. In our study, majority of the patients i.e., 68(87%) were males and the rest 10(13%) were females. Majority of the patients were smokers i.e., 49(62.82%) and 29(37.17%) were non smokers. Of the 78 patients, 42(53.84%) underwent angioplasty and 36(46.15%) underwent bypass procedures for revascularisation. Most of the patients in our study has underwent two debridements 54(69.23%), while 22 (28.2%) has underwent 3 debridements and 2 of them has undergone single debridement. The average latency period found in our study is 35.36 days. Most of the patients 28(35.89%) in our study show a latency period between 21 to 30 days. In our study 42(53.8%) of the cases underwent Negative Pressure Wound Therapy in the latency period. Of the 78 patients 19(24.35%), 12(15.38%), 6(7.69%), 5(6.41%), 4(5.12%), 2(2.56%), 11(14.10%), 9(11.53%), 5(6.41%), 5(6.41%) underwent Latissimus Dorsi flap,Radial free Forearm flap, Gracilis flap, Parascapular flap, Anterolateral thigh flap, Medial Plantar artery flap, Superior Fasciocutaneous Flap, Reverse Superficial Sural Artery flap, Inferiorly based fasciocutaneous flap, Perforator flap. Of the 78 cases, 59 did not undergo any adjuvant procedures, while 7(8.97%), 9(11.53%), 3(3.84%) has undergone Tendo Achilles Lengthening, Ostectomy, Tenotomy. Complications were found in 7( 9%) of the patients, of which 2 of them had ulcer recurrence, 2 of them had hematoma,1 had wound dehiscence,1 had partial flap necrosis,1 had flap necrosis. CONCLUSION: Following revascularization of the diabetic foot which is key to establish the vascularity in ischemic foot and helps in controlling the infection .Infection is also controlled by appropriate antibiotics and wound debridements to remove the necrotic tissues which help in the healing by formation of granulation tissue. Negative pressure wound therapy is used in the latency period to help in the faster healing.Microvascular free flaps bring in well vascularized tissue for the stable cover of the diabetic foot with minimal complications where there is a paucity of locally available flaps. Hand held Doppler is adequate for planning of the reconstructive procedures. Angiogram may not be needed. Adjuvant procedures form an important part in the reconstruction process. Prevention of recurrences is by proper education which is most important. Use of orthotic foot wear ,silicone gel insoles and proper off-loading helps in preventing the recurrences.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Reconstruction ; revascularised diabetic foot. |
| Subjects: | MEDICAL > Plastic and Reconstructive Surgery |
| Depositing User: | Kambaraman B |
| Date Deposited: | 12 Oct 2017 01:46 |
| Last Modified: | 12 Oct 2017 01:46 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3499 |
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