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Document Type |
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Article In Journal |
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Document Title |
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Diabetic foot infection - two years experience Diabetic foot infection - two years experience |
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Subject |
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Vascular Surgery |
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Document Language |
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English |
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Abstract |
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I read with interest the article by Dr. M. R.
Khammash, et all entitled, "Diabetic Foot
Infection, two years experience," (Saudi Med J
1994: 15(3): 227-229.
Certainly, their recommendation regarding a team
approach consisting of general surgeon,
diabetologist, orthopedic surgeon, radiologist as
well as vascular surgeon is accepted in most of the
advanced centers.
However, I found there was little emphasis on
the role of vascular surgeon in achieving the aim
of producing a functioning limb, as they
concluded in the last line of their article. I noticed
that three of their patients had impalpable pedal
pulse and according to the author two ended up
having a below knee amputation. Unfortunately,
there was no mention as to whether they had
studied them carefully prior to amputation,
particularly with regard to the possibility of
performing a peripheral reconstructive vascular
procedure.
Furthermore, the author mentioned that the
third patient did well after the amputation. Most
surgeons do not embark on amputating a
gangrenous toe in the presence of ischemia unless
it is proved beyond doubt with arteriography that
the patient's vascular disease is inoperable. The
simple assumption that diabetic patients have
microvascular disease affecting foot vessels is not
valid.
This misconception was already criticized
heavily in the literature.2 In a recent study,3 we
found that the commonest indication for lower
limb amputation was diabetic foot ulcer. It
accounted for about 50% of the indications for
limb amputation in a series of 123 amputated
limbs.3
Undoubtedly, a detailed vascular assessment is
an essential step in the management of all diabetic
patients. This approach should be followed by
liberal use of the various reconstructive vascular
procedures where applicable.4
As there was no mention of any vascular
procedure performed on their 50 patients, I
thought that I must remind the readers of the
Saudi Medical Journal about our approach in
dealing with this fairly uncommon complication of
a very common disease in elderly Saudis |
|
ISSN |
: |
0379-5284 |
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Journal Name |
: |
The Saudi Medical Journal |
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Volume |
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17 |
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Issue Number |
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4 |
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Publishing Year |
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1416 AH
1996 AD |
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Article Type |
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Comment |
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Added Date |
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Monday, August 24, 2009 |
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Researchers
| حسن الزهراني | Al-Zahrani, Hasan | Researcher | Doctorate | |
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Files
|
20318.pdf
| pdf | Diabetic foot infection |
|