Study of various reconstructive modalities in management of diabetic foots

Diabetic foot ulceration is the most common complication seen in the patient with diabetes with lifetime risk of a foot ulcer as high as 25%, which is the most critical risk factor for lower-extremity amputation. In this study, we have reviewed our experiences with diabetic foot and established an algorithm for surgical reconstruction of diabetic foot. We studied 50 patients and clinical findings based on predisposing factors, complications, treatment and sequalae were studied, analysed and discussed. Split thickness skin graft, local or distant flap surgery was planned according to patient factors. The best possible option was chosen to cover the defect. Patient was monitored in post- operative period for any signs of flap failure and appropriate measures were taken, if required to treat such complications. Out of 50 cases studied, 29 (58%) patients were managed with split thickness skin graft. 14 (28%) patients were managed with flap surgery. Various post operative complications were managed accordingly. The choice of reconstructive modality in the management of diabetic foot ulcers should be based on the specific characteristics of the wound and the patient's overall condition. Skin grafts are suitable for larger wounds over dorsum of foot and wounds over non weight bearing area of sole, while flaps provide stable, supple, durable and sensate coverage. To prevent recurrence, well-padded flap with sensate coverage is needed. Ultimately, the selection of the appropriate reconstructive modality should be made to ensure the best possible outcome for the patients.