diabetic foot. dr.ajit kumar varma

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.

Trans metatarsal and Transtarsal foot amputations.Trans metatarsal and Transtarsal foot amputations.

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

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.

Important Investigations:1.Ankle Brachial Index for macrocirculation.2.Vibration Perseption Testing for Neurapathy.3.tcpo2(microcirculation).4.Pedopodogram for plantar pressure measurements.

Important Treatment modalities:

1.Negative Pressure Wound Therapy2.Anodyne therapy for neuropathy.3.Hyperbaric Oxygen Therapy.4.Stem Cell Therapy.

REVASCULARISATION PROCEDURES

ANGIOPLASTY PERIPHERAL BYPASS

AMPUTATION PREVENTION is our AMPUTATION PREVENTION is our motto.motto.

COMPREHENSIVE TEAM COMPREHENSIVE TEAM APPROACH HAS HELPED US TO APPROACH HAS HELPED US TO

ACHIEVE EXCELLENT FOOT ACHIEVE EXCELLENT FOOT SALVAGE RATE EQUAVALANT TO SALVAGE RATE EQUAVALANT TO

THE BEST CENTERS IN THE THE BEST CENTERS IN THE WORLD. 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