Nather A*, Wei Mae CC, Anwar A and Masturah S
Department of Orthopaedic Surgery, National University Hospital, SingaporeFulltext PDF
Surgical debridement is the commonest operation performed for diabetic foot. It is often left behind to the most junior doctor. However, it needs experience to gauge the extent and depth of debridement needed. It is therefore important that an experienced surgeon should perform it. Good debridement is very often the key to success in the management of diabetic foot wounds. Meticulous assessment must be done pre-operatively. The patient is first assessed for fitness to undergo anaesthesia. Thorough local evaluation of the foot is then performed to assess all 3 components of the Diabetic Foot Triad – vasculopathy, neuropathy, immunopathy. Consent for operation must be carefully obtained. The chance of wound healing is discussed. The need for a repeat debridement or a further operation such as split skin graft must also be explained. The operative procedure is described in detail. Debridement is best performed layer-by-layer to remove all devitalized tissue until healthy bleeding tissue is left behind. The wound is then flushed with normal saline and haemostasis secured. It is best not to leave tendons, bones, fascia and joint capsule exposed. Issues regarding debridement including the use of tourniquet versus no tourniquet, surgical blade versus cutting diathermy, and the use of conventional dressings versus negative pressure wound therapy are discussed.
Surgical debridement; Diabetic foot wound
Nather A, Wei Mae CC, Anwar A, Masturah S. Surgical Debridement for Diabetic Foot Wounds. Clin Surg. 2016; 1: 1040.