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Patients with diabetes usually uncontrolled may develop ulcers in foot. These ulcers starts with very small boil, or redness in toes or foot. If these early signs are ignored and blood sugar is not controlled this may lead to extensive cellulites or an ulcer with purulent pus discharge. This may extend further and can cause gangrene of foot .So to avoid ulcers in foot it is mandatory to do CARE OF FOOT. Proper periodic examination of foot should be done either by your regular physician or yourself CARE OF DIABETIC FOOT
EXAMINATION OF FOOT IN DIABETIC PATIENTS

INSPECTION-skin texture, colour (pale, red, blue, black),

Bony prominences, toe deformities, joint movements,

Fissures, sign and symptoms of infections, scars, dryness of skin, cracked nails, in-growing toe nails,

PALPATION.. warmth, tenderness, calluses

Check movements at ankle and toes

Foot pulses------Peripheral pulses. Vein filling Capillary circulation

NEUROLOGICAL STATUS----motor, sensory----sensation and movments of toes and foot.
THE TEN COMANDMENTS OF DIABITIC FOOT CARE

DO NOT walk bare foot

DO NOT walk bearing weight on affected/ulcerated foot after surgery

DO NOT apply hot fomentation / cold compresses / electric heating pads / strong counter irritating ointments to leg and feet

DO NOT sit cross-legged for many ours

DO NOT remove foot wear during any travel & place your foot at any hot surface. This can cause burns

DO NOT cut corns / calluses with a blade or a knife. Home surgery is dangerous

INSPECT the feet daily for blisters, wounds, bleeding, smell, increased temperature at pressure points of feet & oedema

USE correct footwear. Choose your footwear after consulting your doctor. Always wear footwear with socks with loose elastic

CUT the nails regularly, trimmed square

CLEAN the feet twice a day with soap & water. Wipe the web spaces dry & apply softening agent to feet. Do not use the Pumis Stone
Diabetes is neither an indication for amputation nor contraindication for reconstruction-even major. Timely control of infection, radical Debridment, multiple dressings, proper drainage of collection, control of blood and tissue glucose level, and reconstructive surgery are key instruments to salvage limb

CASE-IPatient of diabetes having ulcer foot for 8 yrs. After control of diabetes, and infection, wide excision of margins and floor including removal of dead Bone .Then local instep flap based on planter vessel was done to cover the ulcer.

CASE-II-Patient with diabetes for 20 yrs, was on Insulin. Ulcer in feet for 10 yrs. Treated with Instep flap based on Medial planter vessels.

CASE III--Patient with leprosy. Amputation was planed because of fowl smell from wound. But after control of infection, flap done and foot was salvaged successfully.

CASE IV-- Diabetic Ulcer foot. Wide excision and rotation flap.

CASE V ----Patient of diabetes with large injection abscess in gluteal region. treated with Gluteus maximus myocutaneous flap.
LARGE TISSUE DEFECTS---- Large tissue defect any where in body may be after extensive trauma or after excision of tissue because of cancer. To reconstruct them in to too is a challenge. The reconstruction depend of how much (size) and what type of tissue (skin, muscle, bone, nerve, vessel ) is missing. Simple cover can be done by split skin grafting. If vital structures are exposed like nerve, vessel, tendons and bone then skin flaps are needed. Skin flaps are faciocutaneous ( skin, subcutaneous tissue, deep facia), myocutaneous (muscle with overlying skin ), composite tissue ( skin, muscle , bone) etc. By use of microvascular technique large amount of tissue can be transfer from one part of body to site of defect. These reconstructive procedure may require more then one stage. Good patients compliance is pre requisite for better reconstruction. Patient should discuss all possible plans and their pitfalls and final outcome before giving consent for any reconstructive procedure.

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