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J Vasc Surg. 2010 Sep;52(3 Suppl):23S-27S. doi: 10.1016/j.jvs.2010.06.004.

Toe and flow: essential components and structure of the amputation prevention team.

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Amputation Prevention Center, Valley Presbyterian Hospital, Los Angeles, CA 91405, USA.


At the end of an anatomic peninsula, the foot in diabetes is prone to acute and chronic complications involving neuropathy, vasculopathy, and infection. Effective management requires an interdisciplinary effort focusing on this triad. In this article, we describe the key factors leading to foot complications and the critical skill sets required to assemble a team to care for them. Although specific attention is given to a conjoined model involving podiatry and vascular surgery, the "toe and flow" model, we further outline three separate models of care--basic, intermediate, and center of excellence--that can be implemented in the developed and developing world.

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