Notes
Outline
Italian Experience in Infection, Limb Salvage & Complex Diabetic Wounds
Luca Dalla Paola MD
Diabetic Foot Dept.
Foot & Ankle Clinic
Presidio Ospedaliero Abano Terme
Bologna University School of Medicine
Italy
www.footankleclinic.it
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FEAR OF COMPLICATIONS
Distribution of Diabetological Structures
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SURGICAL TREATMENT IS, IN DIABETIC FOOT, A MAJOR STEP IN CONSERVATIVE CLINICAL APPROACH
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DIABETIC FOOT CENTER
ACTIVITY (2006)
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"Peripheral angioplasty as the"
 Peripheral angioplasty as the  first choice of revascularization  procedure in diabetic patients with critical limb ischemia: prospective study of 993 consecutive patients hospitalized and followed between 1999 to 2003
E. Faglia MD, L Dalla Paola MD *, et al
Diabetology Center - Policlinico Multimedica, Sesto S. Giovanni (Milan)
*Diabetic foot Unit - Abano Terme Hospital, (Padua)
                               Eur J Vasc Endovasc Surg  29, 620-627 (2005)
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NON INVASIVE VASCULAR ASSESSMENT
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Outcomes of foot lesions
In the 993 PTA patients
17 (1.7%) major amputations
were carried out
3 above and 14 below the knee.
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New tools
New antiseptic agents
Ultrasounds
New debridement devices
VAC therapy
Bioengineered tissues
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SOS Therapy for infected Diabetic Foot Ulcers
L.Dalla Paola, et al WOUNDS Vol.18 ,n.9, Sept.2006
SOS Therapy for infected Diabetic Foot Ulcers
L.Dalla Paola, et al WOUNDS Vol.18 ,n.9, Sept.2006
End Points
Microbiological load reduction
Healing time
Surgical outcomes (conservative, minor amputations, major amputations)
Local adverse effects
Surgical dehiscence
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Use of SOS
Emergent surgery
Elective surgery
Surgical and phisical debridement (Pulsated irrigation-Ultrasounds-Versajet-V.A.C.)
Clinically infected wounds
Skin grafting
Using bioengineered tissues
St Vincent Declaration Advances in Diabetic Foot
Neuropathic foot
Neuroischaemic foot
Infected foot
Multidisciplinary foot clinics
      High limb salvage rate
PEER-REVIEWED- PUBLICATIONS OF ITALIAN DIABETOLOGISTS ON DIABETIC FOOT
ORGANIZATION OF A NATIONWIDE NETWORK FOR THE ASSISTANCE OF DIABETIC FOOT
3rd level
 DIABETIC FOOT UNIT
dedicated to diabetic foot treatment
-All the activity of 1ST and 2nd level.
-Vascular Surgery performing limb salvage with distal by-passes and endovascular procedures.
-Structures and O.R. given over the problem with teams skilled in emergent and elective surgery.
-Charcot foot surgery
-They are teaching centers
2nd level (hospital)
Dedicated structures
Activity characterized by prevention and treatment of wounds. It is guaranteed:
·    Treatment of ulcers
·    Minor surgery
·   Off loading of plantar ulcers
1st level (community)
It provides for risk factors diagnosis (PVD and Neuropathy), prevention and education.
The team includes general practitioners, specialized nurses and diabetologists
Every community diabetologic service has the first level activity
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