1) The document discusses the anatomy and pathophysiology of diabetic foot infections, including details on the plantar arches and spaces of the foot that can be sites of ulcers and infections. 2) It covers the surgical treatment of diabetic foot infections and complications, as well as the biomechanics involved in foot deformities and ulcers. 3) The principles of wound bed preparation are explained, focusing on the TIME framework of Tissue management through debridement, Infection control, Moisture balance, and Edge of wound epidermal advancement. A variety of debridement techniques are outlined.

1. ANATOMY &
PATHOPHYSIOLOGY OF
DISBETIC FOOT INFECTION
DR ARUN BAL
PRESIDENT
DIABETICV FOOT SOCIETY OF INDIA

2. PLANTAR
ARCHES

3. ARCHES OF FOOT
LONGITUDINAL
TRANSVERSE

4. LONGITUDINAL ARCHES
MEDIAL: HIGHER
MORE MOBILE
RESILIENT
LATERAL:LOW
LIMITED MOBILITY
BUILT TO BEAR WT.

6. TRANSVERSE
ARCHES

7. CONCEPT OF PLANTAR
SPACES

8. PLANTAR SPACES

10. SURGICAL TREATMENT OF
DIABETIC FOOT
MID FOOT
ABCESS WITH
TOE GANGRENE
Dr.bal

11. SURGICAL TREATMENT OF
DIABETIC FOOT
DRAINAGE
OF MID FOOT
ABCESS-
POST
OPERATIVE
Dr.bal

12. CROWDING OF TOES CAUSING
ARTERIAL THROMBOSIS

13. ANATOMY OF THE HEEL

14. MAJORITY OF
DIABETIC FOOT
ULCERS ARE IN
THE REGION OF
1ST
MTP JOINT

16. HAWAI(WEB & TOE
STRAP) SLIPPERS
ACCENTUATE TOE
DEFORMITIES

17. HAWAI
SLIPPERS
/STANDING

18. HAWAI
SLIPPERS
/WALKING
TOE
PRESSUR
E

19. PATHO- BIOMECHANICS OF
DIABETIC FOOT ULCCEER
BIOMECHANIC
S OF FORE
FOOT
AMPUTATION
Dr.bal

20. PATH -BIOMECHANICS OF
DIABETIC FOOT ULCER
BIOMECHANIC
S OF
FOREFOOT
AMPUTATION
Dr.bal

21. CAUSE OF 2ND MT
ULCER

22. ANATOMICAL BASIS OF
SPREADING FOOT
INFECTION

28. HEMOSTASIS 1 hour
W
O
U
N
D
I
N
G
Platelets
Fibrin
INFLAMMATION days 1 through 7
Proteoglycans
Neutrophils
Macrophages]
Lymphocytes
PROLIFERATION days 2 through 20
Normal wound
healing
Fibroblasts[produce growth factors]
Collagen
Epithelial Cells
Endothelial Cells
REMODELING 1 week to 6 months
Collagen Fibril Cross linking
Scar Maturation
Time from injury

30. WOUND BED PREPARATION
DYNAMIC & RAPIDLY EVOLVING
CONCEPT
REDUCES THE WOUND HEALING TIME
REDUCES HE COST OF THE
TREATMENT
DEFINATION:GLOBAL
MANAGEMENTTO ACCELERATE
ENDOGENOUS HEALING AND TO
FACILITATE OTHER THERAPEUTIC
MEASURES
IT IS THIRD STAGE OF WOUND CARE
REVOLUTION

31. EVOLUTION OF TIME
FRAMEWORK
T = TISSUE MANAGEMENT
I =
INFECTION/INFLAMMATION
CONTROL
M = MOISTURE CONTROL
E = EDGE/EPIDERMAL
CONTROL

32. TISSUE MANAGEMENT
DEBRIDEMENT
REMOVAL OF NECROTIC, DEVITALIZED,
CONTAMINATED TISSUE
SHARP AND/OR SURGICAL
DEBRIDEMENT
NECROTIC TISSUE MASKES THE
INFECTION
CREATES PHYSICAL BARRIER TO
HEALING
INHIBITS CONSTITUENTS OF
EXTRACELLULAR MATRIX
PREVNETS GRANULATION TISSUE

33. SELECTION OF TYPE OF
DEBRIDEMENT
SIZE,POSITION,TYPE OF THE
WOUND
MOISTURE LEVEL
PAIN MANAGEMENT
TIME AVAILABLE
FACILITIES AVAILABLE
LEVEL OF HEALTHCARE TRAINING

34. SURGICAL OR SHARP
DEBRIDEMENT
FASTEST WAY TO REMOVE
DEBRIS AND NECROTIC TISSUE
MINIMAL DAMAGE TO THE
SURROUNDING TISSUE
RELEASES CYTOKINES THAT
HELPS WOUND REPAIR
NEEDS TRAINING
NEEDS INFRASTRUCTURE

35. SHARP DEBRIDEMENT
A
B
C

36. SURGICAL DEBRIDEMENT
A
B

37. ENZYMATIC DEBRIDEMENT
MOST SELECTIVE
EXOGENOUS PROTEPLYTIC
ENZYMES ARE USED TO RMOVE
NECROTIC TISSUE
WORK WITH ENDOGENOUS
ENZYMES TO DEGRADE THE
NECROTIC TISSUE
MAY CAUSE MINOR TRASIENT
PAIN AND DISCOMFORT

38. Papain-Ures Collagenase
Debridement +++ +++
Speed ++ +
Selectivity - +++
Pain ++ -
Mt.Debridement - ++
Reduce
Bact.Burden
++ +++
Reduce Exudate ++ ++
More Gran.Tissue ++
Epithelization - ++
ENZYME DEBRIDEMENT

39. AUTOLYTIC DEBRIDEMENT
NATURAL DEBRIDEMENT
PHAGOCYTIC CELLS AND
PROTEOLYTIC EZYMES LIQUIFY AND
SEPARATE NECROTIC TISSUE
MOIST ENVIRONMENT NECESSARY
FOR AUTOLYTIC DEBRIDEMENT
CAN RESULT IN TO SIGNIFICANT
WOUND EXUDATE
DOES NOT DAMAGE HEALTHY TISSUE
REQUIRES MINIMAL TECHNOLOGY
AND TRAINING
MINIMAL PAIN

40. BIOLOGICAL DEBRIDEMENT
USE OF LARVAE /MAGGOTS
GREEN BOTTLE FLY LARVAE
USEFUL IN PATIENTS WITH THICK
SLOGH
LIMITED AVAILABILITY
NOT ACCEPTED BY MANY
PATIENTS
ERADICATES INFECTION AND
SMELL

41. MECHANICASL DEBRIDEMENT
NON SELECTIVE METHOD
WOUND IRRIGATION,WHIRPOOL
THERAPY,WET TO DRY DRESSING
SIGNIFICANT DISCOMFORT AND
PAIN
WOUND IRRIGATION IS
UNSUITABLE FOR GRANULATING
WOUNDS

42. MAINTENANCE DEBRIDEMENT
AN EXTENDED PHASE OF
DEBRIDEMENT
REQUIRED DUE TO CO
MORBIDITIES
SIGLE EPISODE OF
DEBRIDEMENT MAY NOT BE
SUFFECIENT
OFFERS DISTINCT ADVANTAGE IN
WOUND MANAGEMENT
ENZYMATIC AND AUTOLYTIC
DEBRIDEMENT IS VERY USEFUL

43. Vacuum-Assisted Wound
Closure
Topical negative pressure therapy
which can be used to achieve closure
of diabetic foot wounds
The pump applies subatmospheric
pressure through a tube and foam
sponge applied to the ulcer over a
dressing and sealed in place with a
plastic film
The dressing is replaced every two to

44. Vacuum-Assisted Wound
Closure
Negative pressure improves the
dermal blood supply, and stimulates
granulation which can form over bone
and tendon. It reduces bacterial
colonisation and diminishes oedema
and interstitial fluid
Course of treatment is usually 7-10
days
The effect may wear off after 3 days
but if the pump is removed and then

45. VAC pump

46. VAC pump dressing

47. VAC pump sponge

48. Healing wound after VAC
pump

49. Healed wound after VAC pump

50. Larva therapy (maggots)
The larvae of the green bottle fly
Lucilia sericata are used to debride
ulcers, especially in the
neuroischaemic foot
This results in relatively rapid
atraumatic physical removal of
necrotic material
Larvae also produce secretions that
have antimicrobial activity against
Gram-positive cocci including MRSA

51. THANK YOU