Surging Ahead - Integrating Basic Research and Applied Science in Clinical Practice in Diabetic Foot
It is often said that Plastic Surgery is more art and science. This comes probably out of the common perception that a plastic surgeon is often involved in the beautification of the nose and face. This does involve a keen sense of observation, flawless surgical techniques, sensitivities, social stigma, regular upkeep and keeping pace with the advances in science and incorporating these into clinical practice. A snip here and a nip there often create that perceived look and expected result. Little do people know that for a few plastic surgeons, this level of finesse and attention to detail also sparked the spirit of adventurism if you like, to venture into other less glamorous but more demanding and tough challenges of not only preventing the hands and feet from being amputated, but to provide comprehensive rehabilitation of the same. Yes, with India being called the diabetes capital of the world, it was not too long that the long standing complications of diabetes started to show up. The feet are the only end organs in the body that once affected and if properly managed can completely be restored to normal. Other organs like the kidney, heart, eye and brain also are affected in diabetes but once their delicate structure is damaged, they need replacement. Feet are unique because if well taken care of, it can be restored to a proper functional state. It has also been found out that, with preventive care, the complications can be successfully avoided. In the event of an undesirable or an unexpected complication, a trained eye can detect early the "red flags" which may herald catastrophe. Believe me, a trained eye is still far more superior to the information gathered from the "all knowing Google". So the science and art of plastic surgery principles have firmly been used to treat the feet in diabetes.
The team at Kauvery Hospital is miles ahead in this field. The team is also very keenly involved in basic research with the best technologic center viz IIT Madras. Years of research and technological innovation have shed new light into the management of this difficult and very neglected field. Prevention of complications, preservation of the foot at its present state, preservation of functional foot and salvage of the foot in the sad event of complications forms the initial goal. Preservation of the salvaged foot and further rehabilitation and finally preventing the recurrence of the sad complications forms the major challenge to a plastic surgeon who has a passion and interest to pursue this aspect of plastic surgery, also called podiatric surgery.
The knowledge, years of experience and keeping the social and financial aspects in mind, the science and art of treating diabetic foot also takes into account not only ability to salvage a limb but to take a firm and educated decision on when to stop attempting to or stop salvage and advise an amputation. This is done purely with the purpose of protecting life - "Life over limb." may take precedence.
Rehabilitation then forms an important sequel. Amputation is not to be taken as a failure of the efforts, but an important procedure, and if done at the right time will ensure that life threatening complications may be prevented.
Welcome to this new team of plastic surgeons who not only mend noses and faces but the feet too with the same skill and dedication and passion too.
Article by Prof V.B.Narayanamurthy, MBBS, FRCS (Glasgow)
Plastic and Reconstructive Surgeon
Department of Aesthetic, Plastic Reconstructive and Diabetic Foot