Plastic surgery involvement in diabetic foot care: A national survey in National Health Service England

Diabetes is the leading cause of major lower limb amputation in the United Kingdom. The cost of Diabetic Foot Disease in England is estimated to exceed £1 billion annually, driven largely by the treatment of foot ulcers and lower limb amputations. Flap reconstruction has been shown to improve limb salvage. The role of Plastic Surgery remains poorly defined in the major leading guidelines on diabetic foot care. A cross-sectional survey was distributed via email to eligible plastic surgery units in NHS England to ascertain the current landscape of involvement in diabetic foot care. Responses were received from 79 % eligible units. Among these, 70 % reported no routine Plastic Surgery representation in their Multidisciplinary Diabetic Foot Team (MDFT). However, 84 % reported receiving at least one referral per annum for diabetic foot-related issues, and 40 % units reported providing 11 or more ad hoc consultations per year. Referrals originated predominantly from orthopedics and vascular surgery. The most frequent reason for referral (65 %) was soft tissue reconstruction following foot ulceration. Notably, 59 % of units reported encountering cases involving failed soft tissue reconstructions initially performed by non-plastic surgeons at least once a year. Plastic Surgery plays a vital yet under-recognized role in diabetic foot management. This survey highlights the need for formalized plastic surgery specialist input in complex soft tissue reconstruction within diabetic foot care.