The surgical treatment of foot
wounds in patients with diabetes is an art and a science. I summarize the surgical management presentation of The
Diabetic Foot Wound Symposium at the 2004 Musculoskeletal
Infectious Disease Society meeting in Pittsburgh, PA. The science of surgical management of the
diabetic foot wound is seen in the accurate diagnosis of its severity. This is accomplished by a simple to use five assessment
wound score that grades
wound base appearance, size, depth, bio-burden and perfusion each from 0 (worse) to 2 (best) using objective criteria. The resultant 0 to 10 score quantifies the severity and provides a guideline for what treatments should be done. The art of surgically treating foot
wounds in patients with diabetes is exemplified in doing
minimally invasive surgeries in the office or their more complex counterparts in the operating room. The surgeries are classified into five types:
debridements, correction of
deformities,
wound closures, partial
amputations, and miscellaneous procedures including nail care and Charcot
arthropathy treatment. The information presented in this paper reflects
my 25 years of experience caring for problem foot
wounds in patients with diabetes.