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Don’t Let Diabetes Pull Down Our Foot 423

 Anatomical
 Aorto-bifemoral

 Ileo-femoral
 Femoro-popliteal
 Extra-anatomical
 Axillo-bifemoral
 Femoro-femoral

9. Tenotomy
Using open method or needle the flexor contracture
is released by cutting the flexor tendon capsule. This
procedure may be used in the treatment of flexible
Fig 7: Hyperbaric oxygen therapy unit
digital contractures, and is especially useful in distal
digital hyper keratotic lesions and/or distal digital
Primary effects of HBOT: ulcerations or in the neuropathic or diabetic patient
• Vascoconstriction with preulcerative or ulcerative distal lesions. This
• Angiogenesis minimally invasive technique has been expanded
to include flexor dominant hammer toe deformities,
• Leucocyte oxidative killing hallux malleus deformities, and floating digital defor-
• Antibiotic properties mities.
• Toxin inhibition The key to choosing this procedure is that the digital
deformity must be flexible or semi-rigid at the inter
7. Negative pressure wound therapy/VAC: phalangeal joint level and no contracture or a reduc-
ible deformity at the metatarsophalangeal joint level
VAC therapy applies sub atmospheric pressure to the
wound to create an environment to promote wound 10. TA Lengthening:
healing by granulation tissue formation
In severe contracture of the foot ,the tendoachilic
VAC has 3 components tendon is partially cut and patient is put on complete

1. VAC therapy unit: provides intermittent and con- cast for 6 weeks. Achilles tendon is one of the main
tinuous negative pressure with safety features biomechanical stresses that led to the ulceration (5).
TA lengthening surgery is perfomed through a longi-
2. Sensa T.R.A.C. Technology: regulates pressure tudinal incision at least 7cm in length. The subcuta-

3. Granufoam / White foam neous tissue must be carefully dissected to reduce
risk of injury to the sural nerve. The deep fascia and
• Removes infectious materials paratenon must be carefully separated and then an-
• Provides protected wound healing environ- atomically re-approximated. This procedure helps in
ment healing of long standing forefoot ulcers in diabetic
foot patients and in preventing recurrence of ulcers
• Removes exudate at forefoot.
• Reduces edema provides moist healing en- Conclusion:
vironment
Prevention is better than cure and most often the Di-
• Promotes perfusion abetic foot ulcer can be prevented when the affected
• Facilitates cell migration and proliferation patient follow adequet foot care as follows

8. Direct Arterial surgical intervention: Educate patients on proper foot care-the
Endovascular: Balloon angioplasty +/-stent DO’s
• Check feet every day for cuts, cracks, bruises,
Surgery: Bypass
blisters, sores, infections, unusual markings

Cardio Diabetes Medicine