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Male : Female Occlusion Vessels adjacent to occlusion Collaterals Lower extremities Vessels involved
Involved Both Tibials Peroneals Small vessel Arterioles Patchy areas of foot and toes Approximately 10 %
The five P5 of acute arterial occlusion Pain Pailor Paresthesias Pulselessness Paralysis
Medical Management
1. 2. 3. 4. 5. 6. Education Exercise Diet Drugs Pancreas transplantation Surgery Saving the Diabetic Foot
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IV. Non invasive evaluations of Peripheral arterial status : the physiological approach
1. 2. 3. 4. 5. Photo phethysmography Doppler Ultrasound Segmental Pressure Toe Pressure Waveform evaluations
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Rehabilitasi KD
Klasifikasi Wagner Derajat : - 0 : Lesi Terbuka kulit utuh deformitas kaki +/- I : Ulkus Sup + pada kulit - II : Ulkus menembus Td & Te - III : Ulkus dalam Osteomielitis +/- IV : Gangren jari kaki atau bag. Distal kaki, dengan atau tanpa selulitis - V : gangren seluruh kaki / tali bawah
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Upaya Pencegahan
A. Primer 1. Penyuluhan kesehatan : - Umum - DM & Komplikasi - Kesehatan kaki 2.Status gizi yang baik & pengendalian DM 3. Pemeriksaan berkala - DM - Komplikasi 4. Prevensi & Proteksi kaki terhadap trauma 5. Pemeriksaan berkala kaki 6. Higiene personal termasuk kaki 7. Hilangkan faktor biomekanis yang memungkinkan terjadinya Ulkus
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Sekunder 1. Aktif mencari kelainan kaki ( case finding ) pada penderita DM & yang potensial DM 2. tx & prevensi kelainan kaki lebih lanjut, tindakan bedah / podiatri 3. Cegah & turunkan kemungkinan komplikasi lebih lanjut 4. Cegah & kurangi / hilangkan kecacatan 5. Pengadaan fasilitas & SDM untuk perawatan kaki diabetik Tertier 1. Fasilitas pengelolaan max/ lengkap 2. terapi lebih lanjut & kontrol periodik - OP - Rehabilitasi Surgikal 14
Grade 0 : There is no open lesion. The skin is intact. There may be deformities such as claw toes. Depressed metatarsal heads. Hallux valgus with bunion, depressed longitudinal arch. Midfoot deformities from Charcot arthropathies, and other bony prominences about the midfoot and heel ( Fig. 11-5 ). Grade 1 : The skin lesion is that of a full-thickness loss but otherwise superficial in nature. Bony prominences may or may not be present ( Fig. 11-6 ) Grade 2 : The open lesion penetrates to tendon, bone, or joint. It thus represent a slightly deeper lesion than grade I ( Fig. 11-7 ) Grade 3 : The lesion has penetrated to a deeper area, and there is osteomyelitis, pyarthosis, plantar space abcess, or infection of tendon and tendon sheaths ( Fig. 11-8 ). Grade 4 : Gangrene is present in some portion of the toes or forefoot. There may be surrounding cellulitis, and the gangrene may be wet or dry ( Fig. 11-9 ) Grade 5 : gangrene involves the whole foot or such a percentage that no local procedures are possible, and a higher amputation is necessary ( Fig. 11-10 )
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