Diabetes and Limb Salvage: Avoiding Infection, Gangrene and Amputation

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Diabetes and Limb Salvage: Avoiding Infection, Gangrene and Amputation
Cardiac and Vascular Institute, NYU Langone Medical Center

What is diabetes?
Diabetes is a carbohydrate metabolism disorder usually characterized by inadequate levels of blood insulin, and excessive blood and urine sugar levels. Diabetes is a systemic disease, adversely affecting many parts of the body.

According to the Centers for Disease Control and Prevention (CDC), diabetes is the 6th leading cause of death in the United States, with 1.3 million new cases diagnosed each year.

If not properly treated, diabetes leads to complications including decreased blood flow in the legs, neuropathy, infections, gangrene, and leg and foot amputation (see below: "Why is diabetes dangerous?").

Medical treatment for diabetes-related complications includes prevention of infection, wound healing, balloon angioplasty, leg bypass surgery, and arterial angiogenesis (see below: "Treatment for Diabetic Foot Wounds").

NYU’s vascular surgeons are diabetic foot experts with extraordinary limb salvage success rates (see below: "NYU’s Limb Salvage Experts").

More information about diabetic problems is available on the Society for Vascular Surgery website.

Why is diabetes dangerous?
If not properly treated, diabetes can lead to:

* blindness
* heart attack
* stroke
* kidney failure
* arterial insufficiency (decreased blood flow in the legs)
* neuropathy (destruction of sensory nerves leading to decreased sensation in the feet)

Diabetic Foot Wounds
Arterial insufficiency and neuropathy can lead to Charcot foot (bony malformations), non-healing feet and leg wounds, infection, gangrene (dead tissue), and amputation.

An infected foot in a person with diabetes is considered a medical emergency. If left untreated, gangrene can result, requiring amputation of the foot.

Infection, gangrene, and amputation are often preventable if patients are educated to carefully monitor their feet for problems, and to seek timely medical intervention when a problem develops.


Treatment for Diabetic Foot Wounds
Treatment of a diabetic foot problem depends on the underlying cause.

Diabetic foot experts at NYU Vascular Associates and the Hospital for Joint Diseases Diabetic Foot Center determine the underlying cause of diabetic patients’ foot problems based on the history of symptoms, nature of the wounds, findings from a physical exam, and non-invasive measurements of blood flow in the legs.

Once the underlying cause of a patient’s diabetic foot problems is determined, surgeons direct treatment accordingly.

Early treatment is the best way to avoid prolonged disability or amputation.

1. pressure wounds
Diabetics with neuropathy can develop wounds from abnormal pressure on a specific part of the foot. Diabetic foot wounds don’t hurt and often go unrecognized by the patient early in their development because of decreased or absent sensation in the foot. These open wounds can become infected, lead to gangrene and require amputation.

Treatment of diabetic foot wounds from pressure is supportive:

1. relieve pressure from the wound surface
2. prevent infection
3. promote wound healing

With proper care, diabetic foot wounds can generally heal themselves. Once the wounds are healed, action must be taken to prevent wounds from recurring.

2. arterial insufficiency wounds
Diabetics are prone to developing blockages in the arteries of the calf (lower leg), leading to inadequate blood flow to the legs and feet. If the foot tissue has insufficient blood flow, minor scratches, cracks or abrasions of the skin may not heal and become enlarged. Scratches, cracks and abrasions can also become infected, leading to gangrene and amputation.

Non-healing wounds due to arterial insufficiency require improved blood flow in order to heal. Treatment options include:

1. balloon angioplasty of arterial narrowing or blockage
2. leg bypass surgery around the blockage
3. therapeutic angiogenesis: the use of experimental medicines to stimulate the vascular endothelial growth factor (VEFG) to grow new blood vessels in the leg


Why choose NYU for diabetic foot treatment?
Diabetes experts at NYU Vascular Associates and the Hospital for Joint Diseases Diabetic Foot Center use state-of-the-art medical treatment and minimally invasive surgery for diabetic foot problems caused by neuropathy or arterial insufficiency.

NYU surgeons are committed to functional limb salvage and preventive medial interventions in diabetic patients at risk of limb loss.

Vascular surgeons at NYU have achieved a 70–80% success rate of leg salvage in patients scheduled for amputation at another hospital (see below: "NYU’s Limb Salvage Experts").

Our Diabetes and Limb Salvage Specialists

NYU Langone Medical Center
550 First Avenue
New York, NY 10016
1-877-4-NYUCVI (698284)

Mark A. Adelman, M.D.
Chief of Vascular Surgery

Neal Cayne, M.D.
Director of the NYU Endovascular Surgery Program

Glenn R. Jacobowitz, M.D.
Vice Chief of the NYU Division of Vascular Surgery / Director of Vascular Surgical Services at Tisch Hospital

Lowell S. Kabnick, M.D.
Director of the NYU Vein Center

Patrick J. Lamparello, M.D.
Vice-Chair of Vascular Surgery / Director of the Vascular Surgery Fellowship Program

Thomas Maldonado, M.D.
Chief of Vascular Surgery, Bellevue Hospital

Firas F. Mussa, M.D.
Assistant Professor of Surgery at the NYU School of Medicine

Thomas S. Riles, M.D.
Associate Dean for Medical Education and Technology / Frank C. Spencer Professor of Surgery

Caron Rockman, M.D.
Director of Medical Education and the Director of Clinical Research for the NYU Division of Vascular Surgery

Frank J. Veith, M.D.
The First U.S. Surgeon to Perform an Endovascular Aneurysm Repair


© 2008 NYU Langone Medical Center