Surgical Approaches to Diabetic Foot Ulcers: An Algorithm for Applying the Reconstructive Ladder



Surgical Approaches to Diabetic Foot Ulcers: An Algorithm for Applying the Reconstructive Ladder

Summary: Narrative review proposes algorithmic surgical DFU management using reconstructive ladder: preoperative optimization (glycemic/vascular/infection), serial debridement, adjuncts (NPWT/DRTs), definitive closure escalating from secondary intention/primary to grafts/flaps. Multidisciplinary orthoplastic approach reduces amputations 62-82%; emphasizes Wagner/Texas/SINBAD classification, offloading, education for durable coverage/ambulation.

Key Highlights:

  • Optimization: HbA1c control, vascular eval, infection eradication.
  • Debridement: Early radical to restart healing.
  • Adjuncts: NPWT for granulation, DRTs as scaffolds.
  • Ladder: Secondary → primary → STSG → local flaps → pedicled flaps.
  • Outcomes: MDT ↓ amputations; flaps for exposed structures.

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Keywords: DFU surgical, reconstructive ladder, limb salvage, flaps, orthoplastic, Subhas Gupta, Janine Myint