Control of infection in the diabetic foot: the role of microbiology, immunopathology, antibiotics, and guillotine amputation.

Newer culture techniques have demonstrated that diabetic foot infections are polymicrobial, involving both anaerobic and aerobic bacteria. These infections are characteristically foul-smelling and create immense tissue destruction. Occasionally, despite the absence of clostridial organisms, subcutaneous gas may be present. The importance of adequate surgical debridement has been emphasized. In the event of advancing, unremitting infection involving the foot, ankle guillotine amputation may be a life-saving technique. Finally, the role of host-defense mechanism in diabetes is important. Polymorphonuclear leukocyte chemotaxis and phagocytosis are energy-dependent processes that are deficient in the diabetic. Better diabetic control with maintenance of normal blood sugars and avoidance of ketoacidosis may be the key to prevention of these morbid, lower extremity infections.