A condition like diabetes makes medical care more complicated, as it is associated with complications in a variety of other body systems, and can result in conditions such as heart disease, kidney disease, nerve damage, and stroke. This complexity has to be taken into consideration for any medical procedure, especially surgery. Plastic surgery is no exception.
Loading the player...Diabetes & Plastic Surgery Dr. Nancy Van Laeken MD, FRCSC, discusses diabetes and plastic surgery.
One of the unfortunate complications of diabetes is that patients are more susceptible to infections and they are more susceptible to poor peripheral perfusion, meaning blood flow is not getting to their fingertips or to their toes.
They often are referred to plastic surgeons for management of these concerns. If patients develop infections in their fingers, pressure sores related to poor circulation into their ankles then they should seek a consultation with a plastic surgeon that can provide suggestions for wound management, but also possibly surgical procedures such as debridement enclosure to allow the wounds to heal more quickly and to prevent ongoing risks of infection in those areas.
In diabetic patients, when the blood sugar is high it creates an environment where they are susceptible to bacterial infections because the bacteria like the sugar in the blood. Therefore, they are more prone to allowing for the bacteria to grow. This is complicated by the fact that their blood circulation to their extremities is poor so the bacteria have the opportunity to thrive in an area of poor blood flow and high blood sugar.
So in order to best manage them it is usually a multi-disciplinary approach. We need the Endocrinologist to manage the blood sugar, and they may need a surgeon to help to debri the wound, suggest a mechanism of wound enclosure. It is very important if there is tissue that is not healthy that it be removed and that it be treated quickly and effectively to prevent spread of the infection and possibly loss of digits because the condition has been allowed to progress for an extended period of time.
Therefore, if any diabetic patient develops an open wound then they should be referred sooner rather than later to a plastic surgeon to have the wounds assessed and recommendations made for management. Presenter: Dr. Nancy Van Laeken, Plastic Surgeon, Vancouver, BC