tailieunhanh - Diabeticcpg small 2 (Part 6)

lization patients transition to a removable cast walker, followed by permanent prescription footwear or bracing (135, 543). Mean time from surgery to therapeutic shoes has been reported to be about 27 weeks (7 months) (135, 140, 530). Careful patient selection and management is the rule with these complex diabetic cases, since amputation can be a complication of failed surgical procedures (138, 474, 511, 527, 528, 533). SURGICAL MANAGEMENT OF THE DIABETIC FOOT (Pathway 6) Surgical management of the diabetic lower extremity can be a daunting task, but with appropriate patient and procedural selection, successful resolution of ulceration and correction. | PATHWAY 6 S-44 THE JOURNAL OF FOOT ANKLE SURGERY lization patients transition to a removable cast walker followed by permanent prescription footwear or bracing 135 543 . Mean time from surgery to therapeutic shoes has been reported to be about 27 weeks 7 months 135 140 530 . Careful patient selection and management is the rule with these complex diabetic cases since amputation can be a complication of failed surgical procedures 138 474 511 527 528 533 . SURGICAL MANAGEMENT OF THE DIABETIC FOOT Pathway 6 Surgical management of the diabetic lower extremity can be a daunting task but with appropriate patient and procedural selection successful resolution of ulceration and correction of inciting pathology may be achieved 270 . Diabetic foot surgery performed in the absence of critical limb ischemia is based on three fundamental variables presence or absence of neuropathy LOPS presence or absence of an open wound and presence or absence of acute limb-threatening infection 270 . Classifications of Surgery Surgical intervention has previously been classified as curative ablative or elective 100 271 . More recently a modification of this scheme has been proposed that encompasses more procedures and a broader spectrum of patients 270 as follows Class I Elective foot surgery performed to treat a painful deformity in a patient without loss of protective sensation Class II Prophylactic foot surgery performed to reduce risk of ulceration or re-ulceration in patients with loss of protective sensation but without open wound Class III Curative foot surgery performed to assist in healing an open wound Class IV Emergent foot surgery performed to arrest or limit progression of acute infection . For any of these classes the presence of critical ischemia should prompt a vascular surgical evaluation to consider the urgency of the procedure and possible revascularization prior to or subsequent to the procedure. Elective Surgery. The goal of elective surgery is to relieve the pain .

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