Challenges of Surgical Management of Diabetic Foot Ulcers
Journal Title: Journal of Quality in Health Care & Economics (JQHE) - Year 2024, Vol 7, Issue 5
Abstract
World Health Organization estimates that about 422 million people worldwide have diabetes, the majority living in low-and middle-income countries. The lifetime risk of developing a diabetic foot ulcer (DFU) is between 19% and 34%. The incidence of osteomyelitis is about 20% leading 20% of moderate or severe DFU cases of 5 years or more duration in lower extremity amputations. Diabetic foot treatment required hospitalization for 60% while around 40% are treated in outpatient services. Healing time is around 20 weeks for outpatients and 30 weeks for patients that require hospitalization. Costs. Treatment for diabetic foot globally costs about 5000 US $ with hospital stay. Conservative approach includes using appropriate antibiotic, after culture and antibiotic sensitivity test with regular debridement, and keeping the wound clean and monitoring the wound healing progress. Most surgeons feel conservative approach is time consuming, coordination challenge, risk for life and an economic burden and therefore are in undue hurry to go for amputation of the effected part. Material & Methods: This article is a qualitative analysis of 4 episodes of DFU in three individuals followed by the author for 6-15 months. First case leading to amputation of Right leg about a decade ago, second another similar case but saved by debridement and dressing by family members in 2023-24. The psychological impact on the second case was very positive despite a 15-month routine of dressings when compared to the first case where the individual lived with depression after the amputation. The third and the fourth episodes were in the same individual leading to amputation of left little toe in late 2022, followed by saving right middle toe of DFU using appropriate antibiotics after culture sensitivity tests and empowering the spouse for debridement and dressings for 5 weeks in late 2023. The patient is repenting for losing the left little toe in a hurry which causes him an embarrassment often. Outcomes: Based on these case studies public health professionals advocate empowering and involving family members in the home care of DFUs to reduce the expenses and minimize lifelong psychological trauma of losing a part of the body by the patient and family.
Authors and Affiliations
Suresh K*
Keywords
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- EP ID EP758802
- DOI 10.23880/jqhe-16000404
- Views 1
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