Elective surgical procedures

Elective surgery includes procedures that are advantageous to the patient but not urgent. For example, correction of a painful bunion or hammer toe in a stage 1 patient (with protective pain sensation, adequate perfusion and well-controlled diabetes) is considered elective. Yet, surgical correction of these same deformities is considered prophylactic surgery when the patient is neuropathic or neuroischaemic and the condition places the foot at risk for ulceration, infection and amputation. The patient's risk of developing a foot ulcer, as well as the patient's healing potential (vascular status) will determine whether a procedure is advisable or not. An important caveat is that patients must have adequate distal perfusion for surgical wounds to heal.

Elective surgery for the well-controlled, low-risk diabetic at stage 1 should be considered the same as for any other healthy patient. The surgical procedures as well as their risks and benefits are essentially the same. A discussion of these procedures is beyond the scope of this chapter, and the reader is referred to standard texts on foot surgery. Instead, the focus of this chapter is on prophylactic and emergent surgical procedures performed on the high-risk diabetic foot.

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