Surgical Approaches to Diabetic Foot Ulcers: An Algorithm for Applying the Reconstructive Ladder
Summary: Narrative review proposes algorithmic surgical management of DFUs using the reconstructive ladder: preoperative optimization (glycemic/vascular/infection control), serial debridement, adjuncts (NPWT, templates), then escalation from secondary intention/primary closure to grafts/flaps based on size/depth/response. Multidisciplinary orthoplastic approach reduces amputations 62-82%; emphasizes staging (Wagner/Texas/SINBAD), offloading, and patient education for durable weight-bearing coverage.
Key Highlights:
- Ladder: Secondary → primary → STSG/FTSG → local flaps → regional pedicled flaps.
- Optimization: HbA1c control, vascular eval, infection eradication.
- Adjuncts: NPWT ↑ granulation; templates for grafts.
- Outcomes: MDT ↓ amputations; flaps for exposed tendon/bone.
- Authors: Subhas Gupta, Janine Myint
Keywords: DFU surgical, reconstructive ladder, limb salvage, flaps, orthoplastic, Subhas Gupta, Janine Myint