Surgical treatment of diabetic foot ulcers: a review of forty-eight cases.

Large vessel disease, small vessel disease, and neuropathy leave the diabetic foot especially vulnerable to ulceration. The degree of vascular impairment of diabetic feet can vary, and such, patients with ulcers can be separated into ischemic and nonischemic groups. The degree of ischemia, and not necessarily the extent of the lesion, is the most significant factor in evaluating the potential outcome of treatment. Forty-eight cases of diabetic ulceration treated with local surgical intervention in an effort to avoid higher amputation were classified as ischemic and nonischemic, based on Doppler studies and physical examination. The success rate in the ischemic group was 25%. The success rate of the nonischemic group was 83%. It is concluded that local surgical management of diabetic ulceration can be a successful alternative to radical amputation in the diabetic patient, especially when adequate blood flow can be verified. Various surgical and nonsurgical approaches to all grades of diabetic feet are also discussed.