Management of the diabetic foot: Surgical and organisational aspects

Most patients are older, but increasing numbers of young patients also develop diabetic foot ulcer (DFU) [1]. A third of the patients are under 50 years of age [2]. The prevalence in the Western countries is 4-10% and the incidence 2-6% [3]. Only 10-60% of patients are healed after the first three months [4] and the recurrence rate is 44%, 61% and 70% after one, two and three years, respectively [5]. DFU results in extensive treatment costs, and the hospital treatment cost of DFU counts towards 25-30% of the total hospital expenses of treatment of patients suffering of diabetes [6]. Recent progress in the treatment of patients with DFU has reduced the number of low-extremity amputation (LEA) cases. These improvements have been achieved through an increasing understanding of the importance of the multifactorial background of DFU, and that there should be a multidisciplinary organised structure behind the treatment of DFU. This used to be a topic of interest, but especially focused on in the International Consensus on the Diabetic Foot from 1999 [3]. Our understanding of the importance of surgery in DFU has increased over the last 30 years [7-17]. A simple classification based on presents or absents of neuropathy, open wound or infection has been suggested [ 16]. Treatment is dependable of the type and classification group of the wound. Various surgical correction techniques are available [18,19]. The team approach and collaboration between all healthcare professionals is required to facilitate good quality holistic care [20-23]. Recognition of the talent and creativity of all employees in the multidisciplinary team will increase the chance of success in establishment of the concept [24]. This article is based on a presentation focusing on the surgical and organisational aspects in the treatment of DFU.