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The deteriorating DFU: prioritising risk factors to avoid amputation

02 July 2017
Volume 1 · Issue 3

Abstract

The risk of amputation in a deteriorating diabetic foot ulcer is high. This article identifies the three major risk factors associated with such an infection—tissue loss, ischaemia and infection—and explains how to identify which risk is most prominent, and what to do to reduce the risk of amputation. Examples are included of how this approach has led to successful patient outcomes

Peripheral arterial disease and diabetes polyneuropathy are the precursors of lower extremity ulceration. They can predispose a limb to further tissue loss and place it at risk of infection. In the unfortunate event that this process ensues, the likelihood of amputation can increase. The treatment of diabetic foot ulceration requires close attention to the three factors that place a limb at risk of amputation: tissue loss, ischaemia and infection. These factors are like three intersecting rings that jockey for dominance over a patient's limb (Fig 1).1 Clinicians must learn how to determine which factor is more dominant. This will help them ascertain which aspects of management should be given priority. Understanding the dynamic between these factors will shed light on what can be done to preserve or salvage a limb. This article provides clinical examples of each of these three rings of dominance. Case examples are also given to illustrate the application of this concept to clinical practice and implementation of the principles of limb salvage.

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