Aster Medcity. Kochi, Kerala, India.. THE DIABETIC FOOT: A SURGICAL PERSPECTIVE. Dr.Ajit Kumar...

Aster Medcity. Kochi, Kerala, India.

THE DIABETIC FOOT: A SURGICAL PERSPECTIVE.

Dr.Ajit Kumar Varma,Dr.Ajit Kumar Varma, M.S.M.S. Senior Consultant,Senior Consultant,

Diabetic lower limb and Diabetic lower limb and Foot & ankle reconstructive surgeon.Foot & ankle reconstructive surgeon.

WHY MAJOR LOWER LIMB WHY MAJOR LOWER LIMB AMPUTATION SHOULD BE AMPUTATION SHOULD BE PREVENTED IN A DIABETIC PREVENTED IN A DIABETIC

PATIENT.PATIENT.

Every 30 seconds a leg is still lost because of diabetes, somewhere in the world.

Let us review some of the Let us review some of the incorrectincorrect practices in India, leading to foot practices in India, leading to foot injuries.injuries.

BARE-FOOT WALKING

Never walk barefoot. It can cause foot problems.Always use prescription Diabetic foot wear.

Rat-bite Injury&

Ant bite injuries

Injury caused by massage –Necrotizing

Fasciitis.

Thermal Injury

Self Surgery,A DangerousPractice.

Interdigital Fungal infections—Immidiate Treatment Required.

Extensive Necrotizing Fasciitis of the leg:---Most of these patients are very sick, some requiring ICU care

Necrotizing Fasciitis of the Foot:---Requires urgent debridement & supportive management.

Necrotizing Fasciitis of the leg; Extensive debridement being done.

Granulating woundsGranulating wounds

Split Skin GraftingSplit Skin Grafting

““OFFLOADINGOFFLOADING” ” the diabetic foot for any foot or the diabetic foot for any foot or lower limb problems is VITAL in lower limb problems is VITAL in the management. the management.

““More than what you put on the More than what you put on the wound, it is what you take wound, it is what you take “ “ OFF OFF ”” from it, that is from it, that is important. ”important. ”

10 commandments of the diabetic foot care:

1. I am thy foot forever. Take good care of me, for thou shalt have no foot other than me.

2. Thou shalt regularly debride me, when I develop callosities and ulcers.

3. Thou shalt fit me with casts and insoles to offload my high pressure areas.

4. Thou shalt carefully look for early signs of infection in me and treat it aggressively.

5.Thou shalt diagnose ischaemia without delay and revasularise me.

6.Thou shalt educate all patients how to examine me and take care of me.

7.Thou shalt carefully inspect the shoes that I have to wear and encourage the use of appropriate footwear.

8.Thou shalt continuously aim to achieve tighter blood glucose control for me.

9.Thou shalt not commit amputation on me, unless there is a compelling reason.

10.Thou shalt try to improve upon your lower limb salvage methods.

INVESTIGATIONS:

tcpo2(microcirculation) PedopodogramPlantar pressure measurements

Negative Pressure Wound Therapy AnodyneTherapyFor Neuropathy

REVASCULARISATION PROCEDURES

ANGIOPLASTY PERIPHERAL BYPASS

CHARCOT FOOT AND ANKLE CHARCOT FOOT AND ANKLE RECONSTRUCTION.RECONSTRUCTION.

MDCT Films of severely destroyed foot and ankle Charcot

Reconstruction:

•Compression screws•On-lay plates•Rush nails•Staples

PRE-OPERATIVE

POST-OPERATIVE Mid and Hind foot Arthrodhesis— Stabilized by the

‘‘SLING TECHNIQUESLING TECHNIQUE’ ’

Hallus Valgus Corrective surgery.

Pre-operative Post-operative.

Prosthesis for destroyed proximal phalynx, Great Toe.

Triplearthrodhesis

PMMA replacement prosthesis for PMMA replacement prosthesis for completely destroyed mid and hind completely destroyed mid and hind foot bones.foot bones.

AMPUTATION AMPUTATION PREVENTION is our PREVENTION is our

motto.motto.

COMPREHENSIVE TEAM APPROACH COMPREHENSIVE TEAM APPROACH

HAS HELPED US TO ACHIEVE HAS HELPED US TO ACHIEVE EXCELLENT FOOT SALVAGE RATE EXCELLENT FOOT SALVAGE RATE EQUAVALANT TO THE BEST CENTERS EQUAVALANT TO THE BEST CENTERS IN THE WORLD. IN THE WORLD.

CONTACT DETAILS:CONTACT DETAILS:

House Address : Dr.Ajit Kumar Varma                AMRITAKRIPA,                49/524-H,                KALPAKA VILLAS,                PARAYIL ROAD,                PUTHUKKALAVATTOM,                PUNNAKKAL,                ELAMAKKARA P.O,                KOCHI  682 026.                KERALA. INDIA. E Mail ajitkumarvarma@gmail.com

Official Address: Dr.Ajit Kumar Varma Senior Consultant. Department of Podiatric Surgery. Aster Medcity Hospital, Kuttisahib Rd, South Chittoor, Kochi--682027. Kerala, India. Email: drajit.varma@dmhealthcare.com Phone: 91 484 6699999