Multisciplinary Team and Diabetic Foot Syndrome
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1 Multisciplinary Team and Diabetic Foot Syndrome Giacomo Clerici MD Roberto Ferraresi MD Amputation Prevention Centre Humanitas Hospitals Group Milan and Bergamo
2 Disclosure Speaker name: Giacomo Clerici I have the following potential conflicts of interest to report: X Consulting Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) I do not have any potential conflict of interest
3 Patient Characteristics 65 years old, male Active smoker Type 1 Diabetes Mellitus Hypertension Retinopathy Carotid stenosis Right achilles tendon reconstruction (1996)
4 Patient Characteristics 2013 PTA and stenting external iliac bilateral (with bilateral chronic occlusion of the SFA) carried out in another hospital Anaphylactic shock immediately after injection of an intravenous nonionic contrast medium November 2017 left heel ulcer that in the last 10 days became infected (fever, WCC , hypotension, cellulitis > 2 cm, bad odour)
5 IDSA 2012: Severe Infection + CLI TcPO2 peri: 17 mmhg No pulses Rest pain PTB +
6 Foot Ankle Int Feb;34(2):222-7.
7 IDSA 2012: Severe Infection + CLI What is the first step?
8 Infection & Ischemia: Timing Diabetic Foot Surgery Class Description Potential Risk for High Level Amputation Class IV: Emergent Class III: Curative Class II: Prophylactic Class I: Elective Procedure performed to limit progression of acute infection Procedure performed to assist in healing open wound Procedure performed to reduce risk of ulceration or reulceration in person with loss of protective sensation but without open wound Procedure performed to alleviate pain or limitation of motion in a person without loss of protective sensation High Moderate Low Very Low J Foot Ankle Surg Jul-Aug;45(4):220-6.
9 Revascularization: When? If insufficient blood flow to the extremities impairs delivery of antibiotics or oxygen, revascularization should be done as soon as the major infection has been adequately addressed
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15 Who have been involved Diabetologist/Foot specialist (first assessment) Foot Surgeon (Urgent Surgical Debrident) Inteventional Cardiologist/Radiologist (Revascularization) Anesthesiologist (anaphylactic shock) Orthopedic Technician (offloading) Nurses (Wound Care Specialist)
16 Who have been involved Diabetologist/Foot specialist (first assessment) Foot Surgeon (Urgent Surgical Debrident) Inteventional Cardiologist/Radiologist (Revascularization) Anesthesiologist (anaphylactic shock) Orthopedic Technician (offloading) Nurses (Wound Care Specialist)
17 Who have been involved 9. Diabetic foot care teams can include (or should ready access to) specialists in various fields; patients with a DFI may especially benefit from consultation with an infec-tious disease or clinical microbiology specialist and a surgeon with experience and interest in managing DFIs (strong, low). D.Armstrong & G.Clerici, Bergamo Clinicians without adequate training in wound debridement should seek consultation from those more qualified for this task, especially when extensive procedures are required (strong, low).
18 Who have been involved Diabetologist/Foot specialist (first assessment) Foot Surgeon (Urgent Surgical Debrident) Inteventional Cardiologist/Radiologist (Revascularization) Anesthesiologist (anaphylactic shock) Orthopedic Technician (offloading) Nurses (Wound Care Specialist)
19 Who have been involved Underestimated & Overlooked treatment!
20 35 mmhg Heel Osteo
21 Who will be involved: next step Diabetologist/Foot specialist (first assessment) Foot/Plastic Surgeon (Foot Reconstruction) Inteventional Cardiologist/Radiologist (Revascularization) Anesthesiologist (anaphylactic shock) Orthopedic Technician (offloading)
22 Foot Reconstruction: Functional Limb
23 Foot Reconstruction: Functional Limb
24 Foot Reconstruction: Functional Limb February 2018 July 2018
25 By reviewing 19 compatible studies on incidence rates for ulcer recurrence,28-46 we estimate that roughly 40% of patients have a recurrence within 1 year after ulcer healing, almost 60% within 3 years, and 65% within 5 years Outpatient setting organized for the FU
26 Foot Reconstruction: Functional Limb
27 6. REMISSION 6. To prevent a recurrent plantar foot ulcer in a at-risk patient with diabetes, prescribe therapeutic footwear that has a demonstrated plantar pressure relieving effect during walking (i.e. 30% relief compared to plantar pressure in a standard of care therapeutic footwear) and encourage the patient to wear this footwear. (Strong; Moderate) SHEARING FORCES PRESSURES FORCES
28 Hospital Stay: How Many Days? 17
29 Thank you Giacomo Clerici MD Roberto Ferraresi MD Amputation Prevention Centre Humanitas Hospitals Group Milan and Bergamo
30 Multisciplinary Team and Diabetic Foot Syndrome Giacomo Clerici MD Roberto Ferraresi MD Amputation Prevention Centre Humanitas Hospitals Group Milan and Bergamo
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