1. WHO SHOULD TREAT THE DIABETIC FOOT? Mohammed Y Al-Naami, FRCSC

2. Is it a debatable issue? General Surgeon Vascular Surgeon Orthopedic Surgeon Plastic Surgeon Podiatrist May be others?

3. The General Surgeon Dr. we have a septic diabetic foot case Can you take care of that Dr.? Yes, I can chop it off, but please don’t ask me more than that

4. The Vascular Surgeon Are there pedal pulses? Yes, Sir. Please refer to General Surgery No, Sir. Please check with the doppler sounds Pedal pulses are audible, Sir Please refer to the General Surgeon

5. The Vascular Surgeon There are no audible doppler sounds, Sir. A~~h, from where you bring me these cases Please try with general surgery again! Sir, they wont accept this case Ok. Ok. Get the patient inn and I’ll see him/her later today or tomorrow

6. The Orthopedic Surgeon Does the patient has any osteomilitis? Yes, Sir Can you try with General Surgery to take care of this patient They wont accept this patient, Sir Ok. Ok. Get the patient inn and consult I.D.

7. The I.D. Consultant Thank you for referral. However, I need bone biopsy from the affected parts Please do this and this and this ……… Antibiotics for at least 6 weeks

8. The Plastic Surgeon Is there any active infection? Yes, Sir Please refer case to General Surgery, and if they need us again they can call us No, Sir Ok. We can see the patient later Next day: By the way where is that patient that you have called me for yesterday? He/She is in ward..and bed.. One week later: Nurse, where is the patient of Dr……..

9. The Podiatrist We have a case for you, Sir. Ok. Can you call the senior surgical resident to see the patient first and let him call me Please. Ok., Sir Senior resident & Podiatrist: After a very long conversation,

10. The Podiatrist Ok. Please consult: Vascular Surgery & Do MRI

11. May be Others? WHO CARES!

12. WHO SHOULD TREAT THE DIABETIC FOOT? Treatment depends on proper limb and foot evaluation Evaluation includes: History and Physical Labs and Radiological studies Vascular Assessment Neurological Assessment

13. Vascular Assessment Evaluation of pulses Evaluation of Skin Doppler Waveform Analysis, Segmental Limb Pressures, and Transcutaneous Oxygen Tension Arteriography

14. CONCLUSION Treatment of a diabetic foot requires multidisciplinary approach The Vascular Surgeon has a major role in evaluation and treatment of diabetic feet Arterial reconstruction may improve wound healing and halts neuropathy

15. CONCLUSION Cont. Control of sepsis should be the prime goal before any further detailed assessment and medical management Prevention of foot wounds and fissures can be facilitated by Physicians and Educators

16. THANK YOU