New progress in the treatment of chronic wound of diabetic foot_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANG Jiangning , GAO Lei

Department of Orthopaedics, Beijing Shijitan Hospital, CMU, Beijing, 100038, P.R.China;

Corresponding?author：

WANG Jiangning, Email: dlwangjn@vip.sina.com

Keywords：

Diabetic foot; chronic wound; complex treatment

DOI：

10.7507/1002-1892.201806058

Video：

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Abstract Full text Figures/Tables Video References Cited by

Diabetic foot is one of the serious complications of diabetic patients. It is caused by diabetes combined with different degrees of lower extremity vascular lesions and neuropathy, and the wound can not heal for a long time. The serious results can cause bone marrow infection, bone destruction, and have high disability and death rate. At present, there are various treatment methods for diabetic foot chronic wound. On the basis of internal medicine controlling blood sugar, anti infection, lowering blood lipid, improving microcirculation and nourishment nerve, the surgical method is adopted, including the debridement of the necrosis in a short time to prevent the infection from spreading; maggot biological debridement and ozone chemical debridement will promote the growth of granulation tissue while controlling infection. Skin grafting, skin flap transplantation, skin distraction closure can be used to repair soft tissue defects, or fat transplantation, platelet-rich plasma, and rich blood are used for the refractory wound after infection control. In patients with diabetic foot, the reconstruction of lower limb blood supply is beneficial to the recovery of chronic ischemic wounds. It is feasible to improve the blood supply of the lower extremities, improve the blood supply of the lower extremity artery bypass grafting, and improve the microcirculation of the peripheral vessels around the lower extremities. Lower extremity vascular bypass pressure perfusion therapy for vascular network expansion, tibia lateral moving technique for lower limb microcirculation reconstruction. For diabetic foot ulcer caused by peripheral neuropathy, such as Charcot foot, while the application of external fixator, total contact cast technology of affected foot for reducing treatment to promote wound healing; the preparation of orthopedic shoes can play a maximum protective effect on the healing of diabetic foot wound healing.

Citation： WANG Jiangning, GAO Lei. New progress in the treatment of chronic wound of diabetic foot. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(7): 832-837. doi: 10.7507/1002-1892.201806058 Copy

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9.	American Diabetes Association. Erratum. Microvascular complications and foot care. Diabetes Care, 2017, 40(7): 986.
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1. International Diabetes Federation. IDF Diabetes Atlas. 6th eds. http://www.idf.org/.
2. International Diabetes Federation. IDF Diabetes Atlas. 7th eds. http://www.idf.org/.
3. World Health Organisation. The top 10 causes of death. World Health Organisation. http://www.who.int/mediacentre/factsheets/fs310/en/.
4. Yazdanpanah L, Shahbazian H, Nazari I, et al. Incidence and risk factors of diabetic foot ulcer: a population-based diabetic foot cohort (ADFC study)-two-year follow-up study. Int J Endocrinol, 2018, 2018: 7631659.
5. Cianci PE. The treatment of diabetic foot ulcers: a historical perspective. Undersea Hyperb Med, 2018, 45(2): 225-229.
6. Ilonzo N, Patel M, Lantis JC 2nd. Managing the diabetic foot ulcer: how best practices fit the real 2018 United States. Surg Technol Int, 2018, 32: 49-59.
7. Tindong M, Palle JN, Nebongo D, et al. Prevalence, clinical presentation, and factors associated with diabetic foot ulcer in two regional hospitals in cameroon. Int J Low Extrem Wounds, 2018, 17(1): 42-47.
8. Walsh JW, Hoffstad OJ, Sullivan MO, et al. Association of diabetic foot ulcer and death in a population-based cohort from the United Kingdom. Diabet Med, 2016, 33(11): 1493-1498.
9. American Diabetes Association. Erratum. Microvascular complications and foot care. Diabetes Care, 2017, 40(7): 986.
10. Didangelos T, Koliakos G, Kouzi K, et al. Accelerated healing of a diabetic foot ulcer using autologous stromal vascular fraction suspended in platelet-rich plasma. Regen Med, 2018, 13(3): 277-281.
11. Everett E, Mathioudakis N. Update on management of diabetic foot ulcers. Ann N Y Acad Sci, 2018, 1411(1): 153-165.
12. Game F. Treatment strategies for neuroischaemic diabetic foot ulcers. Lancet Diabetes Endocrinol, 2018, 6(3): 159-160.
13. Aragón-Sánchez J, Lipsky BA. Modern management of diabetic foot osteomyelitis. The when, how and why of conservative approaches. Expert Rev Anti Infect Ther, 2018, 16(1): 35-50.
14. 馬靜, 顧珮瑜, 陳敏, 等. 血必凈對老年重度糖尿病足圍手術期甲狀腺激素水平影響作用的臨床觀察. 中國醫院藥學雜志, 2013, 33(17): 1412-1414.
15. 姜鵬, 許樟榮. 糖尿病足潰瘍合并感染的抗生素治療進展. 中華糖尿病雜志, 2012, 4(2): 123-125.
16. Akkus G, Evran M, Gungor D, et al. Tinea pedis and onychomycosis frequency in diabetes mellitus patients and diabetic foot ulcers. A cross sectional-observational study. Pak J Med Sci, 2016, 32(4): 891-895.
17. 王玉珍, 許樟榮. 糖尿病神經病變的診治進展. 中國醫刊, 2017, 52(2): 8-11.
18. 姜玉峰, 許樟榮, 付小兵. 糖尿病足創面修復過程中清創問題. 中國實用內科雜志, 2016, 36(1): 13-15.
19. Barwick A, Tessier J, Mirow J, et al. Computed tomography derived bone density measurement in the diabetic foot. J Foot Ankle Res, 2017, 10: 11.
20. Ce?ovsky V, Bém R. Lucifensins, the Insect defensins of biomedical importance: the story behind maggot therapy. Pharmaceuticals (Basel), 2014, 7(3): 251-264.
21. Wilasrusmee C, Marjareonrungrung M, Eamkong S, et al. Maggot therapy for chronic ulcer: a retrospective cohort and a meta-analysis. Asian J Surg, 2014, 37(3): 138-147.
22. Li X, Liu N, Xia X, et al. The effects of maggot secretions on the inflammatory cytokines in serum of traumatic rats. Afr J Tradit Complement Altern Med, 2013, 10(4): 151-154.
23. 高磊, 尹葉鋒, 王壽宇. 純化蛆蟲分泌物抗菌肽對糖尿病大鼠潰瘍創面的抗菌作用. 中國組織工程研究, 2012, 16(24): 4437-4440.
24. 王壽宇, 呂德成, 王媛媛, 等. 蛆蟲分泌物對糖尿病大鼠潰瘍組織 bFGF 和結締組織生長因子表達的影響及抗菌作用研究. 中國修復重建外科雜志, 2008, 22(4): 472-475.
25. Uzun G, Mutluo?lu M, Karag?z H, et al. Pitfalls of intralesional ozone injection in diabetic foot ulcers: a case study. J Am Coll Clin Wound Spec, 2014, 4(4): 81-83.
26. Wainstein J, Feldbrin Z, Boaz M, et al. Efficacy of ozone-oxygen therapy for the treatment of diabetic foot ulcers. Diabetes Technol Ther, 2011, 13(12): 1255-1260.
27. Rosul MV, Patskan BM. Ozone therapy effectiveness in patients with ulcerous lesions due to diabetes mellitus. Wiad Lek, 2016, 69(1): 7-9.
28. Battiston B, Ciclamini D, Tang JB. Compound or specially designed flaps in the lower extremities. Clin Plast Surg, 2017, 44(2): 287-297.
29. Tzeng YS, Deng SC, Wang CH, et al. Treatment of nonhealing diabetic lower extremity ulcers with skin graft and autologous platelet gel: a case series. Biomed Res Int, 2013, 2013: 837620.
30. Jeon H, Kim J, Yeo H, et al. Treatment of diabetic foot ulcer using matriderm in comparison with a skin graft. Arch Plast Surg, 2013, 40(4): 403-408.
31. Mahmoud SM, Mohamed AA, Mahdi SE, et al. Split-skin graft in the management of diabetic foot ulcers. J Wound Care, 2008, 17(7): 303-306.
32. 高磊, 李天博, 劉燕玲, 等. 皮膚牽張閉合器在難愈性褥瘡創面修復中的應用. 中華顯微外科雜志, 2018, 41(1): 80-83.
33. 高磊, 王碩, 王雷, 等. 皮膚牽張閉合器在糖尿病足創面修復中的應用. 中國修復重建外科雜志, 2018, 32(5): 591-595.
34. Song M, Zhang Z, Liu T, et al. EASApprox^? skin-stretching system: A secure and effective method to achieve wound closure. Exp Ther Med, 2017, 14(1): 531-538.
35. Rigotti G, Marchi A, Galiè M, et al. Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose-derived adult stem cells. Plast Reconstr Surg, 2007, 119(5): 1409-1422.
36. Klinger M, Lisa A, Klinger F, et al. Regenerative approach to scars, ulcers and related problems with fat grafting. Clin Plast Surg, 2015, 42(3): 345-352.
37. Nguyen A, Guo J, Banyard DA, et al. Stromal vascular fraction: A regenerative reality? Part 1: Current concepts and review of the literature. J Plast Reconstr Aesthet Surg, 2016, 69(2): 170-179.
38. Assoian RK, Grotendorst GR, Miller DM, et al. Cellular transformation by coordinated action of three peptide growth factors from human platelet. Nature, 1984, 309(5971): 804-806.
39. Knighton DR, Ciresi KF, Fiegel VD, et al. Classification and treatment of chronic nonhealing wounds. Successful treatment with autologous platelet-derived wound healing factors (PDWHF). Ann Surg, 1986, 204(3): 322-330.
40. Kim SA, Ryu HW, Lee KS, et al. Application of platelet-rich plasma accelerates the wound healing process in acute and chronic ulcers through rapid migration and upregulation of cyclin A and CDK4 in HaCaT cells. Mol Med Rep, 2013, 7(2): 476-480.
41. 中華醫學會糖尿病學分會. 2 型糖尿病患者合并下肢動脈病變的篩查及管理規范. 中華糖尿病雜志, 2013, 5(2): 82-88.
42. Toprak O, Cirit M, Yesil M, et al. Impact of diabetic and pre-diabetic state on development of contrast-induced nephropathy in patients with chronic kidney disease. Nephrol Dial Transplant, 2007, 22(3): 819-826.
43. Zaytseva NV, Shamkhalova MS, Shestakova MV, et al. Contrast-induced nephropathy in patients with type 2 diabetes during coronary angiography: risk-factors and prognostic value. Diabetes Res Clin Pract, 2009, 86 Suppl 1: S63-S69.
44. Fichelle JM. How can we improve the prognosis of infrapopliteal bypasses. J Des Mal Vascs, 2011, 36(4): 228-236.
45. 國際血管聯盟中國分會糖尿病足專業委員會. 糖尿病足診治指南. 介入放射學雜志, 2013, 22(9): 705-708.
46. 楊磊, 高磊, 王雷, 等. 體外循環系統下加壓灌注改善模型豬下肢血運. 中國組織工程研究, 2018, 22(4): 553-557.
47. 張紹春, 秦新愿, 左有為, 等. 脈絡寧對體外模擬體內生理環境寄養斷肢系統缺血/再灌注損傷模型的作用. 中國組織工程研究, 2014, (36): 5825-5829.
48. 尹葉鋒, 王江寧, 高磊, 等. 不同溫度對體外模擬體內生理環境寄養斷肢系統的影響研究. 中國修復重建外科雜志, 2013, 27(1): 72-76.
49. 王江寧, 尹葉鋒, 高磊, 等. 不同氧體積分數氣體對體外模擬體內生理環境寄養斷肢系統血氧分壓的影響. 中國組織工程研究, 2012, 16(5): 855-858.
50. Tengfei L, Jiangning W. Remote ischemic conditioning: a novel way to treat ischemia-related injury of limbs. Med Hypotheses, 2015, 84(5): 504-505.
51. Abulaiti A, Yilihamu Y, Yasheng T, et al. The psychological impact of external fixation using the Ilizarov or Orthofix LRS method to treat tibial osteomyelitis with a bone defect. Injury, 2017, 48(12): 2842-2846.
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53. 王斌, 楊漪舸. 股-股動脈旁路移植聯合脛骨橫向骨搬移術治療動脈硬化閉塞癥一例. 中國修復重建外科雜志, 2015, 29(9): 1188.
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