Manajemen Diabetic Foot

Alders Allen Kusa Nitbani

RSUD W.Z. Yohanes Kupang
 Definisi Foot Diabetic

“Infeksi, ulserasi, dan/atau kerusakan jaringan sebagai

akibat dari adanya kelainan neurologis dan kelainan
vaskuler perifer pada penderita diabetes” (WHO 1985)

“…the many different lesions of the skin, nails, bone

and connective tissue in the foot which occur more
often in diabetic patients than non-diabetic patients
such as ulcers, neuropathic fractures, infections,
gangrene and amputations” (De Heus-van Putten,
1994)
 Definisi Foot Diabetic

 “The term “diabetic” foot indicates that there are

specific qualities about the feet of people with
diabetes that sets this disease apart from other
conditions that affect the lower extremity”
(Habershaw & Chzran, 1995)

 “The term ‘diabetic foot’ implies that the

pathophysiological processes of diabetes mellitus
does something to the foot that puts it at increased
risk for tissue damage” (Payne & Florkowski, 1998)
 Definisi Foot Diabetic

- Sekelompok perubahan patologis pada kaki

sbg akibat dari diabetes pada salah satu
atau kedua kaki
- Mengenai kulit, otot, saraf, pembuluh
darah, dan persendian kaki
- Semua struktur di kaki terkena

(Prof. Bala Subramaniam, pada kuliah tamu,

Makassar-2010)
 Mengapa Diabetic Foot penting?

• Menimbulkan kecacatan atau kematian

• Lama perawatan
• Biaya yang cukup besar

Atlas of the Diabetic Foot.

N. Katsilambros, E. Dounis, P. Tsapogas and N. Tentolouris
Copyright © 2003 John Wiley & Sons, Ltd.
ISBN: 0-471-48673-6
International Working Group On Diabetic Foot 2016

 Pada tahun 2035 prevalensi global DM mencapai

600 juta
 480 juta penderita pada negara berkembang
 Lebih dari 24 juta orang pada negara berkembang
menderita kaki diabetik tiap tahunnya
 Lebih dari 8 juta penderita kaki diabetic menjalani
amputasi

Setiap 20 detik AMPUTASI

 Severity related to Neuropathy,
PAD, Infection

Atlas of the Diabetic Foot.

N. Katsilambros, E. Dounis, P.
Tsapogas and N. Tentolouris
Copyright © 2003 John Wiley &
Sons, Ltd.
ISBN: 0-471-48673-6
Atlas of the Diabetic Foot.
N. Katsilambros, E. Dounis, P. Tsapogas and
N. Tentolouris
Copyright © 2003 John Wiley & Sons, Ltd.
ISBN: 0-471-48673-6
 Pathophysiology of the Diabetic Foot
 3 broad types of Diabetic foot
ulcers :
• neuropathic
• ischaemic
• neuroischaemic
 Anatomical distribution:
 ~50% of ulcers are on the
toes;
 ~30-40% are on the plantar
metatarsal head;
 ~10-15% are on the dorsum
of the foot;
 ~5-10% are on the ankle; Djoko Roeshadi
Dr. Soetomo General Hospital
 up to 10% are multiple School of Medicine Airlangga
ulcers. University, Surabaya
Patogenesis
Patogenesis
Patogenesis
 Klasifikasi dan Staging

Mengetahui sumber permasalahan

 Mengetahui prognosis
 Persiapan perawatan luka
 Monitor proses perawatan dan kesembuhan
 Bahan untuk melakukan KIE
 Klasifikasi Wagner
• Grade 0 - Skin intact 0

• Grade 1 - Superficial
ulcer 1
• Grade 2 - Deeper ulcer
to tendon or bone
2
• Grade 3 - Ulcer has
abscess or osteomyelitis
• Grade 4 - Gangrene on 3
forefoot
• Grade 5 - Gangrene
4
over major portion of 5
foot
“Scenario” of The Comprehensive Wound Healing Process
and Its Management
http://www.nhsgrampian.org/guidelines/diabetes/topics/Figu1UnivOfTexaClasSystForDiabFo.html
 EXAMINATION

NEUROISCHEMIC WET GANGRENE

NEUROPATHIC DRY GANGRENE

Pemeriksaan Vasculopathy

Atlas of the Diabetic Foot.

N. Katsilambros, E. Dounis, P. Tsapogas and N. Tentolouris
Copyright © 2003 John Wiley & Sons, Ltd.
ISBN: 0-471-48673-6
 Pemeriksaan Neuropathy

Atlas of the Diabetic Foot.

N. Katsilambros, E. Dounis, P. Tsapogas and N. Tentolouris
Copyright © 2003 John Wiley & Sons, Ltd.
ISBN: 0-471-48673-6
 Prinsip

 Prinsip manajemen kaki diabetik 2 dekade

terakhir berubah dari amputasi menjadi
limb-salvage
 Prinsip penanganan bertujuan untk
mempertahankan panjang kaki dan bipedal
ambulasi
Prinsip Tatalaksana Ulkus Diabetes
 “ Dasar - Dasar Perawatan Luka “

1. Ekstraksi 2. Irigasi 3. Pengkondisian dengan 4. Penge - 5. Pengangkatan

zat-zat asing bahan dressing spesial luaran jaringan mati

1. Larutan Pember - 1. Jahitan pada

makanan luka
sihan
2. Faktor-faktor
2. Staples
pertumbuhan
Stimulasi LUKA Penutupan
3. Kompres 3. Plester peng -
salep ganti jahitan

4. Arus Coverage / 4. Perekat

listrik Perlindungan jaringan

2. Dressing 3. Tubular Dressing 4. Film 5. Special

1. Dressing
siap pakai Dressing Dressing

A novel approach for excelent wound care symposium, Makassar Mei 2008
 Characteristics of an Ideal Wound Dressing
 absorbs excess exudate and
toxic substances

 maintains high humidity at the

wound-dressing interface

 allows gaseous exchange

 demonstrates impermeability to
micro-organisms

 insulate the wound from low

temperature effects

 is free from particulate

contaminants

Do not select a specific type of dressing for a diabetic foot infection with the
aim of preventing an infection or improving its outcome (Strong;
High).
-Recommendation IWGDF No. 23
A novel approach for excelent wound care symposium, Makassar Mei 2008
Recommendation IWGDF
 All patients with diabetes and an ischemic foot
ulcer should receive aggressive cardiovascular
risk management including support for cessation
of smoking, treatment of hypertension and
prescription of a statin as well as low-dose
aspirin or clopidogrel. (Strong; Low)
Recommendation IWGDF
 DO NOT
alter the physical wound
environment
• electricity, magnetism, ultrasound and
shockwaves. (Strong; Low)

select systemic treatments

reported to improve wound healing
• drugs and herbal therapies (Strong; Low)

alter the biology of the wound

• growth factors, bioengineered skin
products and gases (Strong; Low)
Recommendation IWGDF
 Clean ulcers regularly with clean water or
saline, debride them when possible in order
to remove debris from the wound surface
and dress them with a sterile, inert
dressing in order to control excessive
exudate and maintain a warm, moist
environment in order to promote healing.
(Strong; Low)
Recommendation IWGDF

Flexor Tenotomy

www.sydneyorthopaedic.com.au/ankle-tenotomy.html
www.londonfootankle.co.uk/foot-ankle-surgeon/flexor-tenotomy/
“The best solution
is dilution”
 IWGDF risk classification
0 - No peripheral neuropathy
1 - Peripheral neuropathy
2 - Peripheral neuropathy with
peripheral artery disease and/or a foot
deformity
3 - Peripheral neuropathy and a history
of foot ulcer or lower-extremity
amputation
 Prevention:

‘mirror mirror under my feet ,

tell me tell me, are my feet alright
today?’.
 Prevention Guidelines
 IWGDF 0: Once a year
 IWGDF 1: Once every 6 months
 IWGDF 2: Once every 3-6 months
 IWGDF 3: Once every 1-3 months
 Postoperative day – 1, wound treated
First-day presentation Intra op. findings with Sofra Tulle

Week– 3

Week–12
Reno Rudiman, Hasan Sadikin Hospital, Bandung, Indonesia.
 Kepustakaan
 Watkins, Peter J. 2003. The Diabetic Foot. Published on 3 May 2003,
https://doi.org/10.1136/bmj.326.3796.977
 Djoko Roeshadi Dr. Soetomo General Hospital School of Medicine Airlangga
University Surabaya
 Professor P. Bala subramaniam, Singapore
 Atlas of the Diabetic Foot. N. Katsilambros, E. Dounis, P. Tsapogas and N.
Tentolouris Copyright © 2003 John Wiley & Sons, Ltd. ISBN: 0-471-48673-
6
 Clinical Aspects and Management Diabetic Foot in dr Soetomo General
Hospital Surabaya and dr Ramelan Naval Hospital Surabaya, Thomas Erwin
CJH & I Komang Agung IS
 “Scenario” of The Comprehensive Wound Healing Process
and Its Management, Combiphar
 A novel approach for excelent wound care symposium, Makassar Mei 2008
 Stefanus de Soka, Manajemen “Diabetic Foot”
 http://www.nhsgrampian.org/guidelines/diabetes/topics/Figu1UnivOfTexaC
lasSystForDiabFo.html
 www.sydneyorthopaedic.com.au/ankle-tenotomy.html
 www.londonfootankle.co.uk/foot-ankle-surgeon/flexor-tenotomy/