Surgical Approach to Diabetic Foot Infections

The initial examination of a diabetic foot infection (DFI) can occur in the outpatient setting, emergency department, or inpatient setting. When evaluating a patient with suspected DFI, one must perform a detailed history and physical examination in order to determine the most appropriate intervention. The goal of initial surgical intervention is to control and eradicate the DFI by draining an abscess and to sharply remove infected and non-viable soft tissue and bone. Serial surgical debridements may be necessary to completely eradicate the infection. Timing of wound closure is typically determined by the culture results from the most recent surgical intervention in conjunction with the clinical appearance of the tissue. Once wound closure, soft tissue reconstruction, or the definitive soft tissue procedure has been performed, offloading is critical for complete healing to occur. Once the DFI has been eradicated, and/or the wound has healed, prevention of re-ulceration reinfection is critical.