Reconstruction of the Diabetic Foot

The diabetic foot syndrome of vasculopathy, neuropathy, foot ulceration, and deformity can be surgically challenging to the reconstructive surgeon. Primary objectives are to achieve joint stability, restore function, and improve appearance. Within the overall scope of surgical management, soft tissue reconstructive surgeons play an essential role in wound care, debridement, and flap surgery for coverage for non-healing wounds. Soft tissue deficits must be closed to protect underlying structures from infection. Adequate blood flow and debridement of wounds down to clean healthy tissue are mandatory before reconstruction. During soft tissue reconstruction, tightness of closure, depth and location of defect, bulkiness of donor flaps, and donor site morbidity are carefully considered. Given the multi-faceted etiology of the diabetic foot and the complexities involved in managing non-healing wounds, a team approach is critical to the success of diabetic limb reconstruction. This chapter focuses on wound assessment, adequate debridement, and the various options for wound closure or coverage involved in soft tissue reconstruction of the diabetic foot.