Care pathway to save the ischaemic diabetic foot

Podiatry Arena Care pathway to save the ischaemic diabetic foot

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Care pathway to save the ischaemic diabetic foot

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30th June 2006, 10:09 AM

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Care pathway to save the ischaemic diabetic foot

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An integrated care pathway to save the critically ischaemic diabetic foot.
Int J Clin Pract. 2006 Jun;60(6):667-9

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This prospective study describes and evaluates the efficacy of an integrated care pathway for the management of the critically ischaemic diabetic foot patients by a multidisciplinary team. A weekly joint diabetes/vascular/podiatry ward round and outpatient clinic was established where patients were assessed within 7 days of referral by clinical examination, ankle-brachial-index-pressures, duplex angiogram and transcutaneous oxygen pressures. An angiogram +/- angioplasty or alternatively a magnetic resonance angiography prior to surgical revascularisation was performed in patients deemed not suitable for angioplasty based on the above vascular assessment. Between January 2002 and June 2003(18 months), 128 diabetic patients with lower limb ischaemia were seen. Thirty-four (26.6%) patients received medical treatment alone, and 18 (14.1%) were deemed 'palliative' due to their significant co-morbidities. The remaining 76 (59.4%) patients underwent either angioplasty (n = 56), surgical reconstruction (n = 18), primary major amputation (n = 2) or secondary amputation after surgical revascularisation (n = 1). Minor toe amputations were required in 35 patients. The mortality in the intervention group was 14% (11/76). This integrated multidisciplinary approach offers a consistent and equitable service to diabetic patients with critically ischaemic feet and appears to have a beneficial major/minor amputation ratio.

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1st July 2006, 02:50 PM

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3rd July 2006, 12:35 AM

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This is an excellent study which confirms many of our beliefs regarding the treatment of diabetic patients, in that multidisciplinary teams give better outcomes.

Before this study many of us were working towards this, and had anicdotal evidence to show results.

This method of working has been written into the UK National Service Framework for the Diabetic Foot, which is available to order by emailing NDST@prolog.uk.com
or by calling 08701555455 quote NDST024.

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