Infected Ischaemic Foot: Surgical Management

Abstract

The development of infection in the diabetic foot constitutes a foot care emergency, which requires urgent referral to a specialized foot care team. Often, the signs of infection are minimal in the presence of neuropathy, leading to a late presentation. The underlying principles of treatment are to diagnose infection early, culture the bacteria responsible, treat aggressively with antibiotic therapy, and consider the need for debridement and surgery. Usually, antibiotics are commenced as wide-spectrum therapy, which is then focused according to the microbiology culture results. Early surgical intervention is usually necessary as an integral part of infection management. This may include simple debridement of the soft tissues, wide incision, and drainage or open amputation to eliminate extensive areas of infection. Revascularization is an important part of the management of the ischaemic foot that has become infected and may be carried out with endovascular techniques. When tissue destruction is extensive, distal arterial bypass has been established as a valuable procedure in conjunction with surgical debridement, adjunctive reconstructive plastic surgery and antibiotic therapy.