Levels of Diabetic Foot Limb Salvage Units: Trauma Units For Atraumatic Wounds

Just like trauma centers are classified based on resources and community needs, so too amputation prevention units are categorized. Based on many requests, we post these definitions on the ToeAndFlow blog. More of these data can be found in our recent manuscript: Rogers, et al, Journal of Vascular Surgery, 2010. We’re indebted to our long time SALSAmigo, Prof. Sir Karel Bakker for his leadership in helping to disseminate these.

Three Clinical Levels Of Diabetic Foot Care: Basic, Intermediate and Centers of Excellence

Level 3 Basic Model of Care

Aim

Prevention and basic curative care

Patients

Own population

Setting

General practitioners’ office, health center

or small regional hospital

Potential clinicians

–General Practitioner

–Podiatrist

–Diabetic Nurse

Facilitating elements

Close collaboration with a referral center

Level 2

Intermediate Model

Aim

Prevention and curative care for all types of patients and more advanced assessment and diagnosis

Patients

From the regional catchment area of the hospital with possibly some referrals from outside the region

Setting

Hospital

Potential clinicians

–Diabetologist

–Vascular surgeon

–Podiatrist

–Diabetic Nurse

Facilitating elements

Motivated coordinator to inspire team

Exchange experience with other centers

Staff meetings to discuss diabetic foot patients

Active collaboration with other departments within the hospital

Active collaboration with extra-mural facilities (GP’s, nursing homes, etc)

Level 1

Center of Excellence:

Aim

Prevention and specialized curative care for complex cases

To teach other centers

Patients

National, regional or even international referral centre

Potential Clinicians

–Diabetologist

–Vascular surgeon

–Podiatrist

–Orthopaedist

–Orthotist

–Educator

–Plaster technician

–Rehabilitation specialist

–Diabetic Nurse

–Psychiatrist

Setting

Usually a large teaching or university hospital

Facilitating elements

Organize regional, national or international meetings

Allow providers to visit to improve knowledge and practical skills

Active collaboration with other reference centers

Active participation in the development of guidelines

David G. Armstrong

Dedicated to amputation prevention, wound healing, diabetic foot, biotechnology and the intersection between medical devices and consumer electronics.

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