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Volume 87, Issue 5 , Pages 935-950 , May 2008

Surgical Management of Diabetic Foot Infections and Amputations

Thomas Zgonis, DPM
- Thomas Zgonis, DPM, is an assistant professor in the Department of Orthopaedics, Podiatry Division, and the director of the Reconstructive Foot and Ankle Fellowship at the University of Texas Health Science Center at San Antonio. Dr Zgonis has no declared affiliation that could be perceived as a potential conflict of interest in publishing this article.
John J. Stapleton, DPM
- John J. Stapleton, DPM, is an associate of foot and ankle surgery at VSAS Orthopaedics, Allentown, PA, and a clinical assistant professor of surgery at Penn State College of Medicine, Hershey, PA. Dr Stapleton has no declared affiliation that could be perceived as a potential conflict of interest in publishing this article.
Valerie A. Girard-Powell, RN
- Valerie A. Girard-Powell, RN, is a perioperative nurse at the University Hospital, San Antonio, TX. Ms Girard-Powell has no declared affiliation that could be perceived as a potential conflict of interest in publishing this article.
Ryan T. Hagino, MD
- Ryan T. Hagino, MD, is an associate professor in the Division of Vascular Surgery at the University of Texas Health Science Center at San Antonio. Dr Hagino has no declared affiliation that could be perceived as a potential conflict of interest in publishing this article.

A severe diabetic foot infection with gas gangrene, ascending cellulitis, and calcaneal osteomyelitis.

A severe diabetic foot infection with gas gangrene, ascending cellulitis, and calcaneal osteomyelitis.
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An open partial calcanectomy and aggressive incision and drainage are performed immediately.

An open partial calcanectomy and aggressive incision and drainage are performed immediately.
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Vascular consult and intervention is initiated immediately before the subsequent revisional debridement.

Vascular consult and intervention is initiated immediately before the subsequent revisional debridement.
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Negative pressure wound therapy is applied at the second revisional surgery and after appropriate bone and soft tissue cultures are obtained.

Negative pressure wound therapy is applied at the second revisional surgery and after appropriate bone and soft tissue cultures are obtained.
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A hybrid, off-loading external fixator is applied in conjunction with negative pressure wound therapy before the patient is discharged from the hospital.

A hybrid, off-loading external fixator is applied in conjunction with negative pressure wound therapy before the patient is discharged from the hospital.
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A split-thickness skin graft is applied 12 weeks after surgery.

A split-thickness skin graft is applied 12 weeks after surgery.
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A final clinical picture 20 weeks after diabetic limb salvage surgery.

A final clinical picture 20 weeks after diabetic limb salvage surgery.
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indicates that continuing education contact hours are available for this activity. Earn the contact hours by reading this article and taking the examination on pages 947–948 and then completing the answer sheet and learner evaluation on pages 949–950.You also may access this article online at http://www.aornjournal.org.The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, BC, director, Center for Perioperative Education. Ms Holm and Ms Bakewell have no declared affiliations that could be perceived as potential conflicts of interest in publishing this article.This program meets criteria for CNOR and CRNFA recertification, as well as other continuing education requirements.AORN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.AORN is provider-approved by the California Board of Registered Nursing, Provider Number CEP 13019. Check with your state board of nursing for acceptance of this activity for relicensure.