Salvaging diabetic foot through debridement, pressure alleviation, metabolic control, and antibiotics

There is a fatalist perception of diabetic foot because the argument of ‘‘small-vessel disease’’ prevails. This is the report of a cohort study of patients facing a formal recommendation for major foot amputation to assess how many can be saved with ac onventional treatment, def ined as debridement, pressure alleviation, metabolic control, and antibiotics. The primary efficacy measurement was the salvage of the limb at the follow-up visit between 25 an d3 5 days after the fi rst consultation. The secondary efficacy measurement was the subsequent epithelization of the ulcerative lesions, following patients for up to 270 days. The cohort consisted of 105 type 2 diabetic patients; 87 (83%) had severe lesions. A total of 71 patients (68%) required hospitalization. By the intention-to-trea ta nalysis, 89 patients (85%) avoided major amputation. A total of 88 patients were evaluated for complete epithelization, reaching median success by day 120. Overall, 51 patients (49%) underwent minor amputations. It was concluded that there is a high rate of unnecessary major foot amputations, because a diabetic foot ca nb e salvaged across the continuum of severity when patients receive care in a multidisciplinary wound clinic.