When Wounds Require Multidisciplinary Care

Start Page: 14
When Wounds Require Multidisciplinary Care
When Wounds Require Multidisciplinary Care
This 56-year-old diabetic patient presented with multiple digital gangrene and underlying necrosis. She had severe peripheral vascular disease with multiple vessel occlusion and stenosis.
A 72-year-old male presented with a wound that had recently developed on his right great toe. His physician had been managing the wound until it developed a large eschar and infection with drainage.
Here one can see a healthy wound in the same patient with adequate perfusion after he underwent a lower extremity bypass on the right leg and a  subsequent escharotomy.
By Eric H. Espensen, DPM

   Having had the opportunity to oversee a diabetic foot clinic for the last two years has allowed me to witness firsthand how challenging it is to treat. I have been fortunate to be involved in the multidisciplinary team of physicians who have cared for these patients and continue to enjoy the challenge that caring for the diabetic foot presents.

Dr. Espensen currently serves as Section Chair and Chief of Podiatry at Providence St. Joseph Medical Center in Burbank, Calif. He also serves as Associate Director and Director of Research at the Providence Diabetic Foot Center. Along with maintaining a private practice in Burbank, Calif., he serves as contributing editor and consultant for several medical journals and companies. He continues to lecture regularly on the diabetic foot both nationally and internationally.

Dr. Steinberg is a faculty member of the Department of Surgery at the Georgetown University School of Medicine in Washington, D.C.


1. Wagner FW Jr. The diabetic foot. Orthopedics 1987 Jan;10(1):163-72.
2. Reiber GE, Boyko EJ, Smith DG: “Lower Extremity Foot Ulcers and Amputation in Diabetes,” Diabetes in America, 2nd Ed, p409, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, MD, 1995.
3. Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Harkless LB, Boulton AJ. A comparison of two diabetic foot ulcer classification systems: the Wagner and the University of Texas wound classification systems. Diabetes Care 2001 Jan;24(1):84-8.
4. Simmons Z, Feldman EL. Update on diabetic neuropathy. Curr Opin Neurol 2002 Oct;15(5):595-603.
5. Faries, PL, Teodoresce, VJ, Morrissey, NJ, Hollier, LH, Marin, ML. The role of surgical revascularization in the management of diabetic foot wounds. Am J Surg 2004 May;187(5A):34s-37s.
6. Weaver FA, Modrall JG, Baek S, Harvey F, Siegal A, Rosental J, Yellin AE. Syme amputation: results in patients with severe forefoot ischemia. Cardiovasc Surg. 1996 Feb;4(1):81-6.
7. Niezgoda JA, Mewissen M. The management of lower extremity wounds complicated by acute arterial insufficiency and ischemia. Ostomy Wound Manage. 2004 May;50(5A Suppl):1-11.
8. Armstrong DG, Lipsky BA. Advances in the treatment of diabetic foot infections. Diabetes Technol Ther. 2004 Apr;6(2):167-77.
Frykberg RG. An evidence-based approach to diabetic foot infections. Am J Surg. 2003 Nov 28;186(5A):44S-54S.
10. Murphy JV, Banwell PE, Roberts AH, McGrouther DA. Frostbite: pathogenesis and treatment. J Trauma. 2000 Jan;48(1):171-8. Review.
11. Valk GD, Kriegsman DM, Assendelft WJ. Patient education for preventing diabetic foot ulceration. A systematic review. Endocrinol Metab Clin North Am 2002 Sep;31(3):633-58
12. Maciejewski ML, Reiber GE, Smith DG, Wallace C, Hayes S, Boyko EJ. Effectiveness of diabetic therapeutic footwear in preventing reulceration. Diabetes Care. 2004 Jul;27(7):1774-82.
13. Cavanagh PR, Boulton AJ, Sheehan P, Ulbrecht JS, Caputo GM, Armstrong DG. Therapeutic footwear in patients with diabetes. JAMA. 2002 Sep 11;288(10):1231.
14. Cavanagh PR. Therapeutic footwear for people with diabetes. Diabetes Metab Res Rev. 2004 May-Jun;20
15. Tan JS, Joseph WS. Common fungal infections of the feet in patients with diabetes mellitus. Drugs Aging. 2004;21(2):101-12.

image description image description

Post new comment

  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

More information about formatting options

Enter the characters shown in the image.