Foot Attack & Anaesthetic Challenges in Patients With Diabetes

Description

The presentation discusses the concept of "foot attack," an acute condition often requiring prompt intervention due to infected and rapidly progressing soft tissue loss, drawing parallels with myocardial infarctions (MI) and strokes. Verity Currall emphasizes the critical need for rapid recognition, debridement, and appropriate antibiotic therapy, highlighting the importance of multidisciplinary assessments similar to those for hip fractures. Key points include the necessity for immediate surgical intervention in the face of systemic symptoms, with a focus on the urgency of managing necrotic tissue without delay for vascular assessments unless acutely ischemic.



Currall explains a "traffic light" system for debridement practices: red zone for infected tissues, amber for inflamed but questionable viability, and green for healthy vascular tissue. Encouraging thorough debridement, she notes that only complete excision is acceptable; anything less could necessitate follow-up surgeries. Practical tips such as wound shape considerations and using local antibiotics to minimize systemic demands are reiterated, alongside case examples that showcase outcomes following appropriate surgical strategies. The discussion also touches on Charcot's disease as a differential diagnosis, as it can present similarly to infections and stresses the importance of multidisciplinary collaboration in treatment.



Finally, the presentation conveys pearls of wisdom on anesthetic considerations for diabetic patients, the need for effective communication within the surgical team, and the management of contraindications with anticoagulants. It concludes with an emphasis on prioritizing surgical time for foot attack debridement and the importance of co-morbidities, underscoring the message that "time is tissue." The heartfelt acknowledgment of her team and trainers punctuates the presentation.

DOI: 10.1302/3114-230222

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