Sunday, May 06, 2012
Diabetic Ulcer Care:Toe and flow approach
New research supports integration of diabetic foot surgical service with vascular surgery makes significant difference to many suffering from sugar diabetes. Researchers at University of Arizona (UA) found by integrating a collaborative approach more proactive procedures prevented the number of reactive emergency amputations required. The program dubbed "Toe and Flow" has seen more hospitals incorporate multidisciplinary diabetic foot care programs with the addition of vascular surgeons to the team. Now it is more common to find the hospital multidisciplinary diabetic foot care team to consist of diabetologists and endocrinologists (to help control patients’ glycemic levels), podiatrists and foot surgeons (debride and repair wounds and correct underlying deformities), and vascular surgeons (to improve pedal blood flow). Diabetic outpatients with ulcers are principally assessed for blood flow with non-invasive tests such as a pulse exam or Doppler scan. In the ‘toe’ examination, if the flow is deemed adequate patients are managed medically, surgically, and mechanically with the foci to heal and prevent severe recurrence. If the blood supply is determined to be inadequate, the patient is prioritised for revascularisation or ‘flow’. Once an appropriate blood supply is established the patient is returned to ‘toe’ for preventive management. The fundamental change in the “Toe and Flow” approach is the speed in which interdisciplinary interventions to prevent amputation takes place. Healthcare teams are now encouraged to develop environments conducive to rapid communication, consultation, and co treatment. In the US different specialists may all see an in-patient case together, and outpatients are scheduled to see specialists with as little delay as possible between appointments. Nurse practitioners and case managers follow outpatients closely to be sure tests are done as ordered and results reported in a timely fashion. Inpatients are tracked primarily by residents, but nurse practitioners help manage care as well. Research across the world supports the efficacy of multidisciplinary approaches to limb salvage with early revascularization an important part of success.