SURGICAL APPROACH TO DIABETIC FOOT: A COMPREHENSIVE ANALYSIS

Abstract

Diabetic foot is a serious complication of diabetes mellitus, characterized by ulcers, infections, and destruction of the deep tissues of the feet. Surgical treatment is essential in advanced cases, aiming to preserve limb functionality and improve the patient's quality of life. The decision to perform surgery is based on criteria such as the presence of ulcers refractory to conservative treatment, deep infections unresponsive to antibiotic therapy, structural deformities that increase the risk of injury, and tissue necrosis resulting from ischemia. Surgical debridement is one of the most commonly used techniques, consisting of the removal of necrotic or infected tissue, promoting an environment conducive to healing. In cases of deformities such as hammertoes or claw toes, surgical correction can relieve pressure in at-risk areas and prevent the development of new ulcers. Revascularization, through angioplasty or bypass surgery, is crucial to restoring adequate blood flow to the lower limbs, especially in patients with peripheral arterial disease. Amputation, although an extreme measure, may be necessary in cases of severe and irreversible infections, aiming to save the patient's life. Minimally invasive surgery has gained ground in the treatment of diabetic foot, offering advantages such as less surgical trauma, faster recovery, and a lower risk of complications. Techniques such as minimally invasive distal metatarsal osteotomy (DMMO) have proven effective in the treatment of chronic plantar ulcers. Surgical management of diabetic foot requires a multidisciplinary approach, involving vascular surgeons, orthopedists, endocrinologists, nurses, and podiatrists. Thorough patient evaluation, selection of the most appropriate surgical technique, and rigorous postoperative follow-up are essential for successful treatment and the prevention of complications.