VISTA: A clear view forward – a surgical pathway for limb preservation in diabetic lower extremity wounds
DOI:
https://doi.org/10.63676/78vht181Keywords:
limb salvage, diabetic foot, orthotic devices, infection controlAbstract
Importance: Lower extremity diabetic ulcers represent a major global healthcare burden, with high recurrence and amputation rates. Standard wound care pathways often emphasize infection control and short-term healing but neglect the structural and biomechanical drivers of re-ulceration and long-term limb loss. Importantly, these pathways often resort to amputation as a first-line treatment rather than prioritizing limb preservation through early, proactive surgical intervention.
Objective: To introduce VISTA (Vascular Evaluation, Infection Control, Surgical Correction, Technologies & Therapies, and Amputation Prevention) as a comprehensive, surgical-first strategy for limb preservation in diabetic lower extremity wounds.
Evidence review: A narrative synthesis of current diabetic foot ulcer (DFU) literature was performed, emphasizing limitations of conventional care, the role of biomechanical deformity, and the need for proactive, multidisciplinary surgical strategies. The framework was compared against the 2023 IWGDF guidelines and recent innovations in wound care and bone infection management.
Findings: VISTA integrates vascular optimization, aggressive and innovative infection control, early surgical correction of deformities, advanced wound technologies, and a long-term commitment to amputation prevention. Minimally invasive and reconstructive procedures, such as tendon balancing, osteotomies, external fixation, and bioactive biomaterials, are emphasized within a staged, multidisciplinary model. VISTA shifts the care paradigm from reactive to proactive.
Conclusions: VISTA redefines diabetic lower extremity wound care as a forward-looking, surgically oriented pathway that prioritizes early vascular assessment, structural correction, and innovation to achieve durable healing and long-term limb salvage. Large-scale studies are warranted to evaluate its impact on recurrence, amputation-free survival, and cost-effectiveness.
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Data Availability Statement
No new data were generated or analyzed in this study. This manuscript presents a conceptual framework for wound treatment. Data collection is planned for a subsequent retrospective clinical study.
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