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Diabetic Foot Infection and The Vascular Surgeon PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Diabetic Foot Infection and the Vascular Surgeon" by Dr John Bingley.

This medical PowerPoint presentation is about diabetic foot infection, a common and potentially serious complication of diabetes mellitus. It can lead to significant morbidity and mortality, and prompt diagnosis and management are essential. Vascular surgeons play a critical role in the management of diabetic foot infection, particularly in patients with peripheral arterial disease (PAD).

PAD is a common complication of diabetes that can cause reduced blood flow to the lower extremities, leading to ischemia and poor wound healing. In patients with diabetic foot infection and PAD, vascular surgeons can provide essential expertise in the management of ischemia, including revascularization procedures such as angioplasty, stenting, or bypass surgery.

In addition, vascular surgeons can also play a crucial role in the prevention of diabetic foot infections through the management of risk factors such as smoking, hypertension, and hyperlipidemia, which can contribute to the development of PAD. They can also provide education to patients about foot care, including proper footwear and regular foot examinations, to prevent foot ulcers from developing.

In summary, vascular surgeons play a critical role in the management of diabetic foot infection, particularly in patients with PAD. Their expertise in the management of ischemia and their role in the prevention of foot ulcers can help reduce morbidity and mortality in patients with diabetes.

Tags : Diabetic Foot Infection, Vascular Surgeon, diabetes mellitus, peripheral arterial disease, Orthopaedic Surgery, Orthopaedic Surgery PowerPoint presentation

Published on : Jun 23, 2023 | Views : 1296 | Downloads : 4

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Slide 1-

Diabetic Foot Infection and the Vascular Surgeon Dr John Bingley
Slide 2-

What is the problem? A division of the Wound Management Innovation Cooperative Research Centre
Slide 3-

A Simple Clinical Perspective A division of the Wound Management Innovation Cooperative Research Centre Neuropathic 60% Neuroischaemic 30% Ischaemic 10% PAD in DFU is associated with: slower healing amputation risk CVD risk Prognosis Some difficulties with PAD testing in DM ABPI and calcification TBPI Diagnosis of ischaemia is a clinical diagnosis.
Slide 4-

Simple Principles of DFU Management A division of the Wound Management Innovation Cooperative Research Centre
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A Simple Surgical Perspective A division of the Wound Management Innovation Cooperative Research Centre Recognise severe infection and infarction Debride Early Debride adequately
Slide 6-

A Simple Vascular Perspective A division of the Wound Management Innovation Cooperative Research Centre
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85% of DM amputations are avoidable A division of the Wound Management Innovation Cooperative Research Centre
Slide 8-

Simple (?) Recommendations on PAD in DFU (IWGDF 2015) A division of the Wound Management Innovation Cooperative Research Centre Diagnosis: Take a history and examine pulses ABPI and Doppler waveforms Prognosis: If non-healing, and Ankle pressure <50mmHg or ABPI <0.5, consider revascularisation 25% better ulcer healing predictors (skin perfusion >40mmHg; Toe pressure > 30mmHg; TcPO2 >25mmHg) If these are not present, consider revascularisation If no improvement in 6 weeks, consider revascularisation Microvascular disease should not be considered a cause for poor wound healing Treatment: Image the arterial supply down to the pedal arteries Aim to restore direct flow to at least one foot artery (to achieve skin perfusion >40mmHg; Toe pressure > 30mmHg; TcPO2 >25mmHg) DFU need rapid access to vascular treatments After revascularisation, an MDT approach Do NOT do nerve decompression Patient with PAD and a foot infection is high risk for amputation Avoid revascularisation where probability of success is unfavourable
Slide 9-

A division of the Wound Management Innovation Cooperative Research Centre BUT…
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DFU management is an MDT team game A division of the Wound Management Innovation Cooperative Research Centre The guidelines say so: Canadian Diabetes Association Clinical Practice guidelines 2008 Scottish Intercollegiate Guidelines no 116. 2010 Aust National EB guideline 2011 NICE 2011 Diabetes UK 2011 Int Working Group on the Diabetic Foot 2011 and 2015 Int Diabetes Federation Clinical Guidelines Taskforce 2013
Slide 11-

Your new friends: Diabetic Foot Team A division of the Wound Management Innovation Cooperative Research Centre Allied Health: Podiatry Orthotist Occupational Therapist Social Work Pharmacy Psychologist Dietician Nursing: Nurse (Practitioner) Foot Care Nurse Wound Nurse Diabetes Nurse Tissue Viability Nurse Medical: Endocrine Vascular Orthopaedics Plastics ID Emergency General Practitioner Anaesthetics Rehabilitation Psychiatry Dermatology Radiology General surgery General physician Radiotherapy
Slide 12-

A division of the Wound Management Innovation Cooperative Research Centre No single practitioner, or health care profession, can adequately manage diabetic foot ulceration prevention and management
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Diabetic Foot Management is a Team Sport A division of the Wound Management Innovation Cooperative Research Centre
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A division of the Wound Management Innovation Cooperative Research Centre
Slide 15-

Don’t misunderstand or ignore the patient A division of the Wound Management Innovation Cooperative Research Centre
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A division of the Wound Management Innovation Cooperative Research Centre
Slide 17-

“Admit under vascular”DFU MDT…a work in progress A division of the Wound Management Innovation Cooperative Research Centre “Admit under vascular?” WTF? Most DFU is not ischaemic DFU patients are complex ICU for sepsis Long-stay Recurrent debridements High re-admission Multiple teams involved “NOT MY BIN”
Slide 18-

“My Bin” A division of the Wound Management Innovation Cooperative Research Centre
Slide 19-

A division of the Wound Management Innovation Cooperative Research Centre A Team needs a Game Plan DFU Infection Admission Assess foot Pulses palpable Evidence of neuropathy Signs of infection Signs of infarction Texas Wound classification Early Management FBC/ELFT/CRP BGL/Ketones/HbA1c ABG Plain Xray of foot Wound MCS Refer to Vascular Is DM control adequate? Does the patient require immediate surgery? Current Antibiotics/recent MCS Early Management (first 24 hours) Document macro and micro complications HbA1c result arterial status including ABI Wound photograph Endocrinology review Podiatry referral Other team members informed Ortho, ID, Social Work, Dietician, Orthotist, Diabetes educator, Occ Ther. Early Management (first 48 hours) Outcomes BGL control adequate Wound improvement Inflammatory markers improvement Rationalise antibiotics Input from other team members
Slide 20-

A division of the Wound Management Innovation Cooperative Research Centre
Slide 21-

“Look at the Scoreboard” A division of the Wound Management Innovation Cooperative Research Centre Admitted under vascular surgery Diabetic foot pathway Recognise ischaemia and surgical drainage need early Vascular Consultant always present at first debridement Weekly MDT review of inpatients Nursing Vascular OT/PT/Pharm Peri-op Social work Pastoral Care Audit Unplanned ICU admission Length of stay Returns to theatre Unplanned re-admissions Discharged under MDT Second-weekly MDT review of outpatients Podiatry Endocrine Vascular Foot and Ankle Wound Care Process Review Are we doing best practice? Measurement drive Improvement
Slide 22-

A division of the Wound Management Innovation Cooperative Research Centre
Slide 23-

Conclusions A division of the Wound Management Innovation Cooperative Research Centre DFI and ulceration is not a simple disease Complex Care needs an MDT It’s about the patient The Team needs coordination and strategy The Team needs to know what success is