Diabetic foot (DF) is the most frequent chronic complication in both type 1 and type 2 diabetes mellitus, affecting up to 25% of patients at least once in their life and the most frequent cause of non traumatic lower extremity amputation. Ulceration in the foot precedes an amputation in 85% of the cases, so that their correct management is essential to prevent the limb loss.

Introduction: Neuropathic ulcers or minor trauma often lead to severe or limb threatening infections in diabetics. Main principle of infection surgery has always been radical debridement. "Ubi pus, ibi evacua", often cited in medicine is not enough. All necrotic and infected tissue should be resected in case of limb or life threatening infections. Infection control can be difficult or even impossible in case of insufficient debridement or persistence of bacteria.

Cost effectiveness in diabetic feet: Your responsibility!

Diabetic foot ulcers (DFU) are one of the most demanding complications of diabetes. The prevalence of diabetes is increasing exponentially and major amputations remain high cost to patients with loss of independence and life. It has important effects on quality of life and poses important demands on the health care system in terms of manpower and costs.

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The Institution for Healthcare Improvement (IHI) recently estimated that 2.5 million patients�in US health-care institutions develop pressure ulcers (PUs) each year, resulting in�60,000 predicted deaths (ref 1). These ulcers prevent functional recovery and cause substantial pain�and serious infection (ref 2). The annual estimate of treatment costs in the US hospitals is 11 billion dollars,�with a mean length of stay of 13 days (ref 1).

1 Institute for Healthcare Improvement, 2008

Aim: The aim of this study was to determine the impact of different pressure relieving surfaces on the development of pressure ulcers (PUs) and ultimately hospital budgets using a�budget impact model (BIM). The BIM aims to help health service payers understand�the financial implications of changing their portfolio of pressure relieving surfaces.

Pressure ulcers are an all too common problem in health care, affecting large numbers�of�patients�and resulting in a high health system expenditure. Studies examining the magnitude of this problem�provide information needed to evaluate current practice, to improve the quality�of care and to decrease�the number of pressure ulcers.

Working Towards Delayed Primary Closure.

Banwell, P.E., T�ot, L. Topical negative pressure (TNP): the evolution of a novel wound therapy. J Wound Care 2003;12:1, 22-28.

Sugrue M, D?Amours SK, Joshipura M. Damage control surgery and the abdomen. Int J Care Injured 2004; 35; 642-48.

Swan MC, Banwell PE. The open abdomen: aetiology, classification and current

World Society of The Abdominal Compartment Syndrome (WSACS). Part 1. Defintions.Results from the international

World Society of The Abdominal Compartment Syndrome (WSACS). Part 2. Recommendations. Results from the

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Requirements Of An Optimal Device For Temporary Abdominal Closure

Temporary abdominal closure (TAC) has been demonstrated to be an effective method for the

Development of�a Comprehensive Guideline To Improve Outcomes In High-Risk Trauma Patients With Open Abdomens

Kaplan, M., Md, Liebman, J, Md, Wheel, K Md, Bones, K, Rn, Hooper, A, Rn, Servas, P, Rn, And Simms, H Md

Objective: To evaluate a comprehensive multidisciplinary guideline developed to standardize the management of patents with an open abdomen (OA) to improve outcomes.

Methods: Retrospective study on the effectiveness a guideline that was developed at a Level I trauma center to standardize the management trauma patents with OA. Guideline development included: re-definition of the indications for an OA, fluid and blood transfusion guidelines, revised damage control guidelines, expanded use of advanced closure techniques, and expanded use of Vacuum Assisted Closure (VAC). Consensus panel recommendations from two panels were used as well as the definitions of ACS from the WSACS.Two cohorts were evaluated pre and post guideline implementation: Group I (PGL) pre-guideline from 2001-2004; Group II (GL) guideline implementation 2004-2008. Groups were compared for rates of mortality, closure, fistula, multiple organ dysfunction syndrome, intra-abdominal hypertension (IAH), and abdominal compartment syndrome (ACS).

Results: In the study period 456 trauma patents required laparotomy; 27 of 221 laparotomies (12.7%) were in PGL with and of the 236 laparotomies in GL 57 (24.1%) were opened post procedure. Indications to keep the abdomen open were meet in 85% of PGL and 100% in GLgroup. Average ISS was 27 in PGL compared to 24.4 in GL. Closure rates were 70% in PGL with a mean closure time of 23 days and 94% in GL with mean closure time of 6.4 days. Mean IAH for PGL was 29mmHg compared to 16 mmHg in GL (p<. 05). GL group had no reported incidences of ACS compared PGL with 12 patients (45%). PGL had 7 patients (50%) with fistulas compared to 2 (4%) in GL. PGL had VAC therapy in 20% and GL had VAC therapy 100%. There was a 50% incidence of organ failure in the PGL group compared to 4% in GL group. Mortality rates were decreased from 27% in PGL to 17% in GL group (p> .05).

Conclusion: The development of a comprehensive guideline based on established physiologic and contemporary concepts known will enhance and improve the management of trauma patients with an OA improved. Guidelines implementation is effective and had a significant impact in decreasing complications with improved closure rates and decrease in significant complications associated with an open abdomen. Mortality rates decreased but did not meet statistical significance.

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Rationale for consensus on clinical guidelines. Classification, an important step to improve the management of patients with an open abdomen.

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The patient may reach the situation of needing to be treated with an open abdomen (OA)

A consensus group with experts in the field of treating patients with OA met twice in