Frykberg Robert G, Attinger Christopher, Smeets Luuk, Koller Armin, Bal Arun, Kavarthapu Venu
Midwestern University, Glendale, AZ, USA.
Departments of Plastic and Orthopedic Surgery, Medstar Georgetown University Hospital, USA.
J Clin Orthop Trauma. 2021 Feb 26;17:99-105. doi: 10.1016/j.jcot.2021.02.019. eCollection 2021 Jun.
Prevention of amputation has become a key objective of clinicians providing care to patients with high-risk diabetic foot problems. In this regard, the multidisciplinary diabetic foot team (MDFT) has been embraced as the most effective way to manage patients with foot ulcers, infections, and Charcot feet. Importantly, such specialized teams have also integrated various surgical specialties to enable more expedient management of these often complex conditions. Experienced diabetic foot surgeons over the last three or four decades have contributed much to this discipline, whereby foot-sparing reconstructive procedures or minor amputations have become fundamental strategies for limb preservation teams. Central to limb salvage, of course, is the recognition of underlying vascular insufficiency and the importance of prompt (endo)vascular intervention. Restoration of adequate perfusion is essential to allow the podiatric, orthopaedic, or plastic surgeon to perform indicated functional reconstructive or minor amputation procedures. This evidence-based overview discusses the various indications and surgical principles inherent in modern concepts aimed at preventing amputation in the high-risk diabetic foot.
预防截肢已成为为患有高危糖尿病足问题的患者提供护理的临床医生的关键目标。在这方面，多学科糖尿病足团队（MDFT）已被视为管理足部溃疡、感染和夏科氏足患者的最有效方式。重要的是，此类专业团队还整合了各种外科专科，以便更迅速地处理这些通常较为复杂的病症。在过去三四十年里，经验丰富的糖尿病足外科医生为这一学科做出了很大贡献，由此保肢重建手术或小截肢手术已成为肢体保全团队的基本策略。当然，肢体挽救的核心是认识到潜在的血管功能不全以及及时进行（血管内）血管干预的重要性。恢复充足的灌注对于让足病医生、骨科医生或整形外科医生进行指定的功能性重建或小截肢手术至关重要。本循证综述讨论了现代理念中旨在预防高危糖尿病足截肢的各种适应症和手术原则。
