Diabeticcpg small 2

Descriptors for these considerations (62, 290, 291). For example, the University of Texas San Antonio (UTSA) system (Table 6) associates lesion depth with both ischemia and infection (290). This system has been validated and is generally predictive of outcome, since increasing grade and stage of wounds are less likely to heal without revascularization or amputation (290, 293). The UTSA system is now widely used in many clinical trials and diabetic foot centers.

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lization patients transition to a removable cast walker, followed by permanent prescription footwear or bracing (135, 543). Mean time from surgery to therapeutic shoes has been reported to be about 27 weeks (7 months) (135, 140, 530). Careful patient selection and management is the rule with these complex diabetic cases, since amputation can be a complication of failed surgical procedures (138, 474, 511, 527, 528, 533).

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Figure 12 Diabetic neuroarthropathy, or Charcot foot, is believed to be a neurologically-mediated complication of diabetes, with the development modified by musculoskeletal stress. The result is osseous fragmentation and joint subluxation with often significant morphologic changes in the architecture of the foot. Complications of the Charcot foot include ulceration under areas of bony prominence and potential amputation often related to infection/osteomyelitis that develops adjacent to the area of ulceration. ...

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Indicators for frank infection will also include pain (especially in the neuropathic patient), erythema, and induration. When bone or joint is visible or palpable at the depth of the ulcer, osseous infection becomes more likely (285, 423). A thorough discussion of the management of infected wounds is presented later in this document and summarized in Pathway 4. Unrecognized ischemia will also impair wound healing and must be diagnosed prior to development of infection or ischemic necrosis of the ulcer.

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Figure 4 Diagnostic imaging plays an important role in the evaluation of diabetic foot infections. (A) This patient presented with a deep foul-smelling necrotic ulcer of the heel that had been present for more than 1 month. (B) In the past, a technetium bone scan typically would be performed, but the imaging is nonspecific and many false positive results interpretative as osteomyelitis were seen. (C) White blood cell tagged imaging with indium or technetium is a more reliable technique for detecting the presence of infection. ...

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A Supplement to: The Journal of Foot & Ankle Surgery DIABETIC FOOT DISORDERS A CLINICAL PRACTICE GUIDELINE Development and publication of this Clinical Practice Guideline was made possible by an Educational Grant Co-Sponsored by Johnson & Johnson Wound Management, a division of ETHICON, INC. and KCI USA, Inc. An official publication of the American College of Foot and Ankle Surgeons Supplement to: The Journal of Foot

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