Clinics in podiatric medicine and surgery
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The podiatric physician often encounters complex painful neuropathies in daily practice. Diabetic neuropathy is one form of chronic neuropathic pain dealt with on a regular basis. The goal of this article is to review the pathophysiology, diagnosis, and treatment options of this complaint. Medical and surgical interventions are discussed, with a clinical emphasis on patient selection and prevention.
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Clin Podiatr Med Surg · Jul 2007
ReviewSurgical management of diabetic foot infections and osteomyelitis.
Foot ulceration and subsequent infection are a major complication of diabetes mellitus. Without proper diagnosis and treatment, these infections often lead to amputation. ⋯ When conservative measures fail or when faced with limb- or life-threatening infection, surgical intervention, whether it be incision and drainage or possible amputation, is warranted. The authors review underlying pathophysiology of diabetic foot infections and an evidenced-based approach to surgical management, with additional emphasis on treatment of osteomyelitis.
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Clin Podiatr Med Surg · Jul 2007
ReviewCurrent perioperative treatment of patients with type 1 and type 2 diabetes.
Diabetes mellitus is rapidly increasing, diabetic patients are likely to undergo surgical procedures more than non-diabetic patients, the hospital stay of diabetic patients is longer, and diabetic patients have increased mortality and morbidity. The correct treatment of diabetic patients in the perioperative period is crucial to improve clinical outcomes. ⋯ Metabolic control deserves great attention because hyperglycemia is related to increased complications and worse outcomes. Insulin infusion regimens to achieve near normoglycemia must be implemented in surgical and critically ill patients.
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Clin Podiatr Med Surg · Jul 2007
ReviewAdvanced plastic surgery techniques for soft tissue coverage of the diabetic foot.
Obtaining stable, durable, and functional wound closure of a diabetic foot wound or open pedal amputation through plastic surgical techniques is essential to limit the potential for repeated ulceration, infection, and "supra-pedal" amputation. Myriad conservative and surgical techniques can be used to obtain wound closure. The authors discuss their approach and present operative pearls for their most commonly employed plastic surgical techniques to provide adequate soft tissue coverage of diabetic foot wounds. Emphasis is placed on the techniques necessary to perform these procedures and the surgical thought process involved in closing diabetic foot wounds.
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The increasing pervasiveness of diabetes mellitus on a global stage has been well documented. Many groundbreaking studies have detailed the consequences of inadequate glycemic control, but only recently have data supported evidence that demonstrates benefits in the acute setting. ⋯ This article discusses glycemic control, with special emphasis on the perioperative patient. Emerging therapeutic treatments and less frequently encountered protocols such as insulin pump management and insulin infusion are considered.