Fifteen percent of individuals with diabetes will likely develop foot ulcers in their lifetime, and approximately 15% to 20% of these ulcers are estimated to result in lower extremity amputation. Techniques to prevent lower extremity amputation range from the simple but often neglected foot inspection to complicated vascular and reconstructive foot surgery. Appropriate management can prevent and heal diabetic foot ulcers, thereby greatly decreasing the amputation rate and medical care costs. Prevention is the key to treatment. The author discusses general guidelines for foot screening and identifies three specific goals for prevention of amputation: 1) identification of at risk individuals needing prevention and the specific factors placing them at risk; 2) protection of the foot against the adverse effects of external forces (pressure, friction, and shear); and 3) reduction of the incidence of diabetic foot ulcers through educational programs.
To assess the outcome of transmetatarsal amputations of the foot, data were analyzed for all transmetatarsal and midfoot amputations performed at the Lebanon Veterans Health Administration Medical Center for the period 1984 to 1990. During this 6-year period, 42 consecutive transmetatarsal and midfoot amputations were performed on 39 patients. Patient demographics, factors leading to amputation, level of amputation, outcome, function, and long-term complications were analyzed. Overall healing rate was 83.3%, with an average length of hospital stay of 35.7 days (range 3 to 96 days). Average follow-up period was 30.2 months (range 2 to 65 months).
A case of human myiasis caused by the black blowfly, P. regina, has been presented. Although various reports have documented the therapeutic effects of maggot infestation, infection and mortality by gas-forming anaerobic organisms also have been reported. The removal of maggots from a wound can be accomplished using various methods. The authors successfully used topical application of dichlorotetrafluoroethane.