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3 - The role of orthopedics in multidisciplinary approach to diabetic foot wounds
Yavuz Arıkan, Ünal Kuzgun, Cem Sever, Rafi Armağan
Objective: Owing to management of diabetic foot wounds (DFW) need severe and long-term treatment protocol that concerns many departments; diabetic foot ulcers necessitate multidisciplinary approach. Therefore a council was constituted that called Wound Council, included five deparments (endocrinology, infectious diseases, dermatology, orthopedics and plastic surgery) in Sisli Etfal Research an Training Hospital. The purpose of this study was to inform about the wound council and to emphasise the role of orthopedic approach to DFW.
Methods: A total of 42/154 patients (29 male and 13 female; mean age:66) who had DFW, were evaluated on Sisli Etfal Research and Training Hospital - Wound Council and were decided to be treated by 1. Orthopaedics and Traumatology Clinic were included in this study. Patients demographic findings such as gender, age, location and duration of wound, wound culture, results of angiography, presence of vascular pathology, blood sugar levels, wound stages according to Wagner classificaion, surgical prosedures, complications and period of hospitalization were noted.
Results: Fifty one meeting were done in Sisli Etfal Research and Training Hospital - Wound Council between 2007-2009 and 154 patients were assessed. 120 of patients (76 male, 44 female and mean age:58.6) had diabetes (type 1/2=3/117). Wound durations were changing between 2 weeks and 18 years. 42 of these patients who were hospitalized to 1. Orthopedics and Traumatology Clinic had tipe 2 diabetes mellitus (DM) and their mean wound durations were 3.4 month. Staphylococcus aerius were the more spawning microorganism. According to Wagner classification; more half of patients were stage 4 and 5 (55.7%). 59.5% of patients had lower knee and 23.8% of patients had upper knee amputations. In addition debridement and drainage were applied to five of them, hyperbaric oxygen therapy (HBO) were added 3 of them and vacumm assisted closure (VAC) were added in 3 of them each. Reamputation precedure were applied to 9 of patients who had infection on postoperative follow-up period. Period of hospitalization period were 4-22 days (mean:13.2).
Conclusion: Consultation traffic of necessary departments for the patients who have DFW decreases with mutidisciplinary approach. Weve understant that orthopedic practice has an important place in this team. According to our study; for effective treatment of this DFW patients, multi clinical assessement can increase the success instead of single approach.
Keywords: Diabetic foot, chronic wound, multidisciplinary approach, orthopedics, amputation
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