Structured health care for subjects with diabetic foot ulcers results in a reduction of major amputation rates
A frequent consequence of diabetes is lower extremity amputation (LEA), treating foot ulcerations and using an effective structured health care program (SHC) could reduce the occurance of LEA.
Diabetic patients with newly detected foot ulcers are subdivided into 4 categories depending on the blood supply still reaching the foot. Test subjects with signs of sever blood shortage to the entire limb are refered to vascular surgeons, to see if vascular reconstruction or radiological treatment are possible. Where this is not possible either; prostglandis lipids, low-dose urokinase protease enzymes or stem-cells are applied to improve blood perfusion. After acute treatment patients within all 4 categories receive intensive diabetes education alongside rehabilitation. At discharge indvidual theraputic footwear is also received. During hospital treatment 4.7% underwent amputation above the ankle and 3.2% in the following 2 years, this compairs to a total of 21.7% in a control group.
Considering that, at intake, approximatly 88% were graded a modified UT-wagner wound classification 2,3 or 4; the SHC can be seen to have a postive effect in reducing the number of diabetic patients with foot ulcers who suffer LEA. The implimentation by a multidiscplinary diabetic foot team would signficantly increase limb preservation > From Weck et al., Cardiovasc Diabetol 12 (2013) 45. Article distributed under the terms of the Creative Commons Attribution License.
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