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Semin Plast Surg 2010; 24(1): 043-056
DOI: 10.1055/s-0030-1253239
© Thieme Medical Publishers

Functional Reconstruction of the Diabetic Foot

Mark W. Clemens1 , Christopher E. Attinger1
  • 1Department of Plastic Surgery, Georgetown University Hospital, Washington, District of Columbia
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Publication History

Publication Date:
05 May 2010 (online)

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ABSTRACT

The diabetic triad of neuropathy, vasculopathy, and foot deformity can be surgically challenging to the reconstructive surgeon. Soft tissue deficits must be closed to protect underlying structures from infection and to provide a stable environment for healing. It is critical to have adequate blood flow and to debride the wound to clean healthy tissue before considering reconstruction. Surgical options commonly used include healing by secondary intention, local flap closure, skin grafts, pedicled flaps, and free tissue transfer. Despite a surgeon's best operative efforts, these strategies may fail perioperatively due to postoperative shear forces created by premature joint motion and/or pressure (either weight bearing or decubitus). In the properly selected patient population, external fixators serve as an indispensable adjunct to wound healing in the Charcot foot by providing temporary but reliable offloading and/or immobilization of joints. Using a team approach is critical to the success of diabetic limb reconstruction.

KEYWORDS

Diabetes - reconstructive surgery - neuropathy - lower-extremity flaps

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Christopher E AttingerM.D. 

Director, Wound Healing Center, Professor of Plastic and Orthopaedic Surgery, Georgetown University Hospital

3800 Reservoir Road, Washington, DC 20007

Email: cattinger@aol.com