Le pied diabétique expérience du service de dermatologie a l’hôpital militaire Moulay Ismail de Meknès (A propos de 49 cas)

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AuteurQassimi F
DisciplineHôpital Militaire d’Instruction Mohamed V Rabat
EncadrantElhaouri M

Diabetic foot is a major public health problem, not only nationally but also worldwide, because of its prevalence, morbidity and the high cost of its management. Our work is a retrospective descriptive study about epidemiological, clinical, therapeutic and evolutionary profiles of 49 patients, who were hospitalized at the Dermatology Department of HMMI Meknes during 10 year (from January 2005 to December 2014), for diabetic foot. The average age of our patients was 61,18 years and 81,63 % were male. The diabetes 2 was predominant (87, 76 %). Its average evolution duration was 8,95 years (1 year- 40 years) and our patients were relatively undisciplined in the monitoring and compliance of their diabetes treatment and diet. The lesions most found were : phlegmon 32.65 %, the diabetic foot ulcer 28.57% , ischemic necrosis 14.28%, gangrene 8.16% . The starting of the lesions was a tramatism causing wound’s surinfection in 79.6% of cases, intertrigo inter- toes ( neglected or mistreated ) in 14.28% of cases and superinfected eczema in 6.12 % of cases . The main etiological factors found were arterial disease in 18,39 % of cases, neuropathy in 59,17 % of cases and both in 22.44 %. The infection was found in 79.59 % of cases. The treatment recommended for our patients was a medical one, associated to local care adapted and supervised in 89.8 % of cases, and surgical in 10.2 % of cases. The average hospital stay was 18.57 days. In this study, we discuss the concordance and the particularities of our results compared to literature data. More than ever, it is imperative that appropriate actions are taken to ensure access to quality care for all people with diabetes, regardless of age, location or social status. We hope that the global awareness of diabetes and foot complications continues to get intensified .The role of the dermatologist is primordial in the management of diabetic foot because, for complete healing of skin lesions whose origin is multifactorial, he provides a multidisciplinary care.After this work, we find that the recommendations on the management of diabetic foot lesions seem misapplied. The challenge remains the reduction of the frequency of amputations by imposing a multidisciplinary approach adapted first, and then rigorous prevention strategy, which necessarily requires the establishment of specialized centers, to finally provide patients the best quality of life possible