Routine diabetic foot debridement | Figure 1

Routine diabetic foot debridement

68 years old male a retired military officer has DM since 1995 and he said he was taking metformin until 2022 when he started taking premixed insulin injections. He had done 5 PCI and 4 foot catheterisations at different time intervals and takes atorvastatin for hyperlipidemia and hypertension controlled on amlodipine; they were both diagnosed in 2018.

Okay condition started in 2017 when the patient started to feel gradual pain like walking on pedals on the ventral aspect of his left foot, continuous and progressive. It radiated to calf muscles, aggravated by walking long distances, and relieved by pain medication or by rest after walking. After 3-4 months, his little toe of the same foot started to change colour to blue then black without smell or discharge. He went to the doctor who told him to routinely wash and sanitise the area twice a day. After 1-2 months, he noticed small worms coming out of his little toe and the area around the third to fifth metatarsal on the ventral aspect. He returned to the same doctor who prescribed anti-inflammatory medication and antibiotics as tablets and injections which he continued to take for 2-3 months. After that, he returned to the same doctor who advised him to amputate his little toe. After a while, they started to amputate his fourth toe and then his third toe; lastly, they amputated his first toe, each at different intervals he does not remember when. After this series of amputations, he changed his doctor who wants to perform a lower limb arterial bypass for him, but he is waiting for anaesthesiologist approval because of his heart condition. The surgeon can’t perform a full leg amputation because he doesn’t have enough blood supply in the limb to support it. During the time he waits, he is admitted to the hospital for 6 times, each lasting for 1-3 days for debridement of his foot gangrene. In this seventh admission, lasting for 14 days, his foot debridement is done two times a day. When I saw him two days ago on Monday, he was prepared for surgery on Wednesday (which is today), and the anaesthesiologist approved for it. He accepts all responsibilities for any complications that occur during the surgery and will not file any lawsuits or tribal arbitration against the hospital or surgeon.

Possible Surgery Complications

What are the possible surgery complications that can occur given his medical conditions?

Update 1

Surgery was done on the planned date and it was successful, and he was discharged.