Wound coverage in diabetic foot

The term “Diabetic foot” means surgical lesion of foot in diabetic patients which is due to slow and steady progress of long term complications i.e. neuropathy, microangiopathy; thereby making the management of diabetic foot as one of the most challenging aspect particularly salvaging the limb. Wound healing is delayed in patients with diabetes because of above said factors. Reconstructive procedures can be done in the form of Split thickness skin graft (STSG) and Flaps, local, regional or free.

In this study various methods of wound coverage have been compared in diabetic foot.

Forty four patients were registered for the study. Wound cover was given in the form of STSG or Flap. If no bone or tendon was exposed then STSG was done; while with exposed bone or tendon with only small defect, small foot-muscle flap/local flap was planned; and with large defects regional flap was planned. In cases of compressive neuropathy tarsal tunnel release was done.

The results were judged by the graft or flap healing, donor site morbidity, adequate wound coverage with ambulation with or without footwear and associated complications. Of the 44 procedures done, complications were seen in 20 (45.45) cases. Partial STSG loss was the most common complication, seen in 10 patients (22.73) cases. Results showed maximum 24 (54.55%) fair results and 14 (31.8%) good results. Procedure proved poor in six (13.64%) patients.

A radical debridement should be done to remove all necrotic tissue followed by early coverage of the wound with graft or flaps. All kinds of flaps can be done in diabetics with expected good recovery but choice of flap is very important.