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Treatment of the Diabetic foot - Focus on NPWT
Multiple modalities are present. One of the commonly used ones is Negative Pressure/Vacuum Assisted Closure etc. However rampant use/misuse of this therapy has led to less than optimum results and loss of limbs. I present here some of our findings with regard to the use of VAC/NPWT in the diabetic foot in the hope that using various therapies appropriately as per wound requirement will help in salvage rather than loss of limbs. No therapy is an end unto itself and any therapy needs to be used as per stage of the wound. Regular follow up of the patient by the treating doctor rather than leaving it to paramedics and wound care company reps, is in the best interest of the patient. Wound care is about getting down and in and be willing to get your hands dirty, rather than just scanning the wound from afar using pics.

Diabetic foot infection in a diabetic patient with hypertension.Patient had a history
of previous amputation of the 2nd toe.
Patient presented with a central plantar abscess and infection extending to the ankle.
Sugars were raised >450mg% and leucocyte counts were > 25000/cu mm.
Debridement and central plantar
space exploration was carried out at
the Save Legs Diabetic Foot Care
Clinic in Hyderabad
Culture & sensitivity results showed
multiple resistant organisms
Advanced wound care materials were used and
systemic management was done.
Patient healed completely without loss of any other part
of the foot and was mobilised in customised footwear

These are pictures of a patient who came with a necrotic Achilles tendon and after treatment at multiple outside centres. Patient was a diabetic with peripheral arterial disease and was in sepsis and severe pain on presenting to us. The leg and overall condition were assessed and patient taken up for surgery. The whole posterior compartment of the leg was necrotic as the picture shows. After surgery and advanced wound care, patient was mobilised after complete healing in about two months.

Diabetic patient with central plantar abscess. Patient had calcified vessels and chronic kidney disease. Supportive therapy was started. Surgery to debride and drain the central plantar space was done. Patient was put on Hyperbaric oxygen and silver dressings. Patient healed completely and was mobilised in customized footwear.
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