Advanced Diabetic Gangrene Procedure
Diabetes is a major contributing cause of vascular arterial disease. In particular Diabetes can cause a particularly severe form of gangrene in the lower limbs. This disease can be difficult to control and can result in loss of the limb.
Whilst there are many contributing causes of diabetic foot problems, a lack of blood supply (ischaemia) remains the most important predictor of amputation. Unfortunately, Diabetes often causes small vessel disease, where the small arteries in the calf, foot and digits (toes) can become blocked leading to gangrene. Recognition of ischaemia is vital to successfully treating and saving the diabetic foot with gangrene. Traditionally the only curative treatment available for this pattern of small vessel disease was amputation of the gangrenous tissue.
Advanced Diabetic Gangrene Treatments offered in our practice include small vessel angioplasty. This is a technique originally developed in Europe, where the small vessels in the calf, foot and digits can be accessed via an angiogram and opened with a balloon and/or stent. This results in immediate improvement of blood supply to the offending gangrenous wound thus allowing the healing process to begin.
Indications and Investigations
This procedure is usually recommended for patients where conservative therapies have failed. Often patients find themselves undergoing multiple courses of antibiotics. They may also be advised amputation rather than surgical treatments to save the limb. An assessment is made of the limb to determine the state of the blood supply to the wound. This often involves diagnostic ultrasound, Ankle/Brachial and Toe/Bracial pressure measurements, TranscutaneousOxegyn measurements in the foot and Diagnostic Angiogram. If the wound related artery is found to be blocked, angioplasty of the vessel is recommended.
Preparing for Surgery
Before undergoing surgery, inform your doctor about any medications or supplements you are taking. You may need to discontinue certain medications. Also, inform your doctor about any existing medical conditions or illness. Avoid oral intake of any food or drink, including water, for about 9 to12 hours before your surgery. Your prescribed medications can be taken along with a small sip of water.
During the procedure, a balloon and wires are placed into the arteries of the foot. The procedure is performed in the operating room with the patient under general or local anaesthesia with mild sedation. Your doctor will make a tiny incision over the groin and insert a small tube called a catheter into the femoral artery. With the help of X-ray imaging, the catheter is guided to the site of the blockage. Wires are then used to cross the blocked artery, and balloons/ stents are then placed over the wire to re-open the artery. After the procedure X-rays are taken to ensure the artery is open and flowing into the wound. The catheter is then removed and the incision, in your groin, is closed.
After the Procedure
After the surgery, you will be kept in hospital overnight for observations. You will be given blood thinning medications to prevent blood clot formation.
As with any type of surgery, there are some risks associated with small vessel angioplasty techniques. These include infection, bleeding, blood clot formation, kidney damage, and heart attack.
Factors such as severity and extent of the disease in the foot, medical co-morbidities and general fitness may increase the risk of complications from the procedure.