In Germany, 250,000 people fall ill with diabetic foot syndrome every year. Sooner or later, many of them have poorly healing and chronically progressing wounds due to poor blood circulation in the lower extremities. Chronic wounds can lead to the amputation of toes, the foot or the entire leg. 40,000 diabetics are affected by this every year and are diagnosed with „amputation“, but often too quickly and too frequently, because 80 percent of all amputations could be avoided by professional treatment, explain experts such as Dr. Dirk Hochlehnert, a diabetologist from Cologne. The Joint Federal Committee (G-BA) has just decided that an independent second opinion by a specialist such as a diabetologist or a vascular surgeon within ten days of the diagnosis of the surgeon who wants to amputate the limb will be paid for by health insurance companies. It was also possible to obtain a second opinion beforehand, but now every affected person has a legal right to it. In addition, the attending physician is obliged to provide advice and information for a second opinion. There is only one exception and that is in emergency situations, when an operation has to be performed immediately. Work is currently underway on telemedical second opinion procedures in order to provide optimal care for patients in rural areas. In any case, relatives and friends should always be important partners who participate in consultations with independent specialists after diagnosis, because patients are often completely overwhelmed by the situation. The search for a suitable „second-meiner“ can be done on the Internet at www.116117.de/zweitmeinung. In addition, health insurance companies also provide tips for a suitable specialist. Alternatively, the website of the AG Fuß of the German Diabetes Society (DDG) is also available, or the advice of an emergency team in certified DDG outpatient clinics, which can be reached under the telephone number 0180/3123406. If the specialist then, after detailed consultation and diagnosis, makes a decision other than amputation, the patient decides on the possible rescue of the lower extremities. Vascular examinations in advance usually speak in favor of rescuing the foot or leg, explains Prof. Dr. Gerhard Rümenapf, Chief Physician of the Clinic for Vascular Surgery at the Deaconess Foundation Hospital Speyer. However, in 50 percent of all cases this measure is not even considered, although it makes sense. Narrowed and blocked leg arteries are the reason for amputations in half of those affected and can be avoided in 90 percent of all cases by removing the narrowed area. But often it is also sufficient if poorly healing wounds are simply treated consistently and correctly. Correct wound management in the form of, for example, custom-made plaster casts and footbeds, but also the wearing of suitable shoes can lead to success in some cases.
