Here - EWMA 2013

ORAL PRESENTATIONS
105
Key Session: Recent Evidence – Vascularisation and Amputation
Revascularisation in the diabetic foot: why is a multidisciplinary
approach essential?
Gerd Rümenapf 1
1 Diakonissen-Stiftungs-Krankenhaus Speyer (Speyer, Germany)
Eight million Germans have diabetes. Their feet are threatened by polyneuropathy as
well as peripheral arterial disease (PAD). PAD is present in half of the 250.000 diabetic
foot ulcers/year. Ulcer recurrence is 70 % at 5 years. Despite great fanfare, only little has
changed since the St. Vincent declaration in 1989.
Methods: “Time is tissue” in a” foot attack”. Early detection and treatment of ischemia
helps to avoid amputations. In Germany, the interval between occurrence of the foot
lesion and specialized treatment is up to 3 months, due to lacking knowledge and
awareness in the outpatient sector, and no communication with hospital doctors. We
have successfully attacked this problem by organizing a widespread network of
practitioners, diabetologists, and associated hospitals surrounding our interdisciplinary
vascular center.
Revascularisation by endovascular or surgical techniques should be performed soon.
“Endovascular” is the first option. The availability of a method and the expertise of the
vascular center are more important than the technique itself.
Perioperative care (metabolic/ infection/ pain control, wound care, offloading) requires
an interdisciplinary team. Since the rehospitalisation rate of diabetic foot patients is high,
we have developed an integrated clinical case- and discharge management, using a
new score to identify patients at risk.
Postop multidisciplinary care comprises wound management, offloading, podiatry,
provision of appropriate footwear, and controls of the arterial reconstruction using color
ultrasound.
Conclusion: Revascularization in the diabetic foot solves the problem only if the patient
is kept in “remission” by the efforts of a multidisciplinary foot care team.
KEY SESSION: RECENT EVIDENCE – VASCULARISATION AND AMPUTATION
106
Key Session: Recent Evidence – Vascularisation and Amputation
Revascularisation of the ischemic diabetic foot ulcer
– where is the evidence
Robert Hinchliffe 1
1 George’s Vascular Institute, St George’s Healthcare NHS Trust (London, United
Kingdom)
NOT AVAILABLE AT TIME OF PRINT
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