An Interventional Study of Surgical Offloading Procedures in Chronic Non-Healing Diabetic Foot Ulcers in A Tertiary Care Hospital in Puducherry

Abstract

Complicated diabetic foot ulcer is one of the most common causes of hospitalization in diabetic patients and 15% of them develop foot ulcers at some point in their lives. Amputations of the lower extremities are frequently caused by ulcers. In more than 80% of cases, diabetic foot ulcers lead to lower extremity amputations. It is therefore imperative to prevent re-ulceration and heal ulcers in order to prevent amputations.

The purpose of this protocol is to assess the efficacy of surgical offloading procedures (Keller arthroplasty, Metatarsal head resection , Gastroc-soleus recession, Weil osteotomy , Gastroc-soleus recession, Bony exostosis excision, Debridement-Local/ Abductor hallucis flap cover) in eliminating the mechanical etiology for the formation of chronic non-healing ulcer in diabetic foot and thereby aiding in healing and prevention of recurrence of ulcer. We studied the pressure difference pre and post-surgical offloading procedures in diabetic foot ulcers and thereby in ulcer healing and preventing further complications.Careful patient selection and thorough evaluation of the foot as well as attendant co-morbidities are the cornerstones of achieving successful results, in otherwise very complicated patients. Early and ostensibly aggressive surgical intervention on the deformed foot can obviate many months of unsuccessful conservative care, especially when ulcer recidivism becomes the primary challenge. Great care (with close follow-up) is necessary in the postoperative period to ensure optimal outcomes in these high-risk patients. It is concluded that relieving pressure on ulcers should always be a part of the treatment plan.TCCs and non-removable walkers are the preferred non-surgical interventions; however, the clinician should be aware of possible drawbacks of these devices.S urgical offloading  techniques  reduce the pressure over the ulcer area and thereby promotes ulcer healing and decreases recurrence.