A UK surgeon believes plastic surgery is the solution for patients with diabetes who are at risk of losing a limb, suggesting that ‘some of the most neglected people are those living with diabetic foot disease’.
James Chan is a consultant in reconstructive plastic surgery who wants to see the technique rolled out across the UK. He maintains that soft tissue reconstruction can potentially affect diabetic foot salvage.
Although a popular treatment protocol in other countries around the world, there are only a few hospital trusts in England that routinely offer limb-saving plastic surgery for diabetic patients with foot ulcers.
Staff at Stoke Mandeville Hospital in Aylesbury, Buckinghamshire, where Mr Chan is based, carry out a small number of operations each year to preserve patients’ feet and avoid major amputation.
In April, he spoke at the English Diabetes Footcare Network National Conference about the role of plastic surgery in foot reconstruction.
He said: ‘Diabetic foot disease represents one of the most challenging modern reconstructive problems. It is associated with poor wound healing, peripheral vascular disease, immunosuppression and deep infection.
‘Limb preservation likely improves quality of life and perhaps even life expectancy. However, the lack of soft tissue coverage is often a limiting factor and an indication for proximal amputations. There has been increasing interest in using plastic surgery techniques to reconstruct these defects. At present, this is not routinely offered in most healthcare facilities.’
He said some of the most neglected people are those living with diabetic foot disease, but members of the diabetic foot MDT can transform lives by being proactive and enabling patients to get back up on their feet again.
He added: ‘I also believe there are many patients in whom it would be possible to preserve limbs if only we can offer soft tissue reconstruction which is not routinely offered in most healthcare centres at present. To this end, I founded and now lead the Special Interest and Advisory Group on Diabetic Foot Reconstruction for the British Association of Plastic, Reconstructive and Aesthetic Surgeons.’
Mr Chan is based at Stoke Mandeville, Wycombe General and Amersham Hospitals in Buckinghamshire and he holds a Lectureship at Oxford University.
He graduated from Cambridge University and completed a Doctorate of Philosophy at Oxford University as a Senior Scholar of Lincoln College. Subsequently, he completed his higher surgical training within the Oxford region. He underwent specialist microsurgery training in Taiwan, which allowed him to develop the techniques to perform limb salvage reconstructive surgery for diabetic foot disease.
About one-third of people with diabetes develop a foot ulcer during their lifetime. Diabetic foot ulcers affect about 18.6 million people worldwide.
It also comes with a heavy price for the UK’s NHS – costing more to treat than breast, prostate and lung cancer combined.
