Surgical management of the acute severely infected diabetic foot – The ‘infected diabetic foot attack’. An instructional review

• Published in: Journal of clinical orthopaedics and trauma Vol. 18; pp. 114 - 120
• Main Authors: Ahluwalia, R.S., Reichert, I.L.H.
• Format: Journal Article
• Language: English
• Published: India Elsevier B.V 01.07.2021; Elsevier
• Subjects: Debridement; Foot attack; Outcomes; Severe diabetic foot infection; Surgery; Diabetic Foot Infection; Foot attack; Debridement; National Institute for Health and Care Excellence; Surgery; Severe diabetic foot infection; Diabetic Foot Ulcer; Outcomes; International Working Group of the Diabetic Foot; National Institute for Health and Care Excellence, NICE; International Working Group of the Diabetic Foot, IWGDF; Diabetic Foot Infection, DFI; Diabetic Foot Ulcer, DFU
• ISSN: 0976-5662; 2213-3445
• DOI: 10.1016/j.jcot.2021.04.012

Diabetic Foot Infection (DFI), in its severest form the acute infected ‘diabetic foot attack’, is a limb and life threatening condition if untreated. Acute infection may lead to tissue necrosis and rapid spread through tissue planes, in the patient with poorly controlled diabetes facilitated by the host status. A combination of soft tissue infection and osteomyelitis may co-exist, in particular if chronic osteomyelitis serves as a persistent source for recurrence of soft tissue infection. This “diabetic foot attack” is characterised by acutely spreading infection and substantial soft tissue necrosis. In the presence of ulceration, the condition is classified by the Infectious Diseases Society of America/International Working Group on the Diabetic Foot (IDSA/IWGDF Class 3 or 4) presentation requiring an urgent surgical intervention by radical debridement of the infection. Thus, ‘time is tissue’, referring to tissue salvage and maximal limb preservation. Emergent treatment is important for limb salvage and may be life-saving. We provide a narrative current treatment practices in managing severe DFI with severe soft tissue and osseous infection. We address the role of surgery and its adjuvants, the long term outcomes, potential complications and possible future treatment strategies. •3 important pathologies; infection, ischemia & neuropathy, cause acute necrosis and life threatening sepsis in diabetic feet.•Careful history, examination within a MDFT – for neuropathy, ischemia and infection are essential for effective management.•Early diagnose, anatomical spread, infection load assessment in the foot will correctly prioritise the patient.•Debridement of severe or significant infection should be performed by a trained surgeon in a protocolised manor within 24 h.•Infection control is the 1st-stage of limb salvage followed by surgical reconstruction for long-term functional salvage.