Clinical application of nose ring drain in severe diabetic foot infection_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 TIAN Lin ¹ , Aikebaier·Yasen ¹ , TAN Yuzhong ² , LI Faxiang ² , GAO Bo ² , CHENG Liangkun ² , HE Dong ² , QU Long ²

1. Microsurgery Center for Wound Repair, Chongqing Great Wall Hospital, Chongqing, 400041, P.R.China;
2. Department of Orthopedics, Aerospace 731 Hospital, Beijing, 100074, P.R.China;

Corresponding?author：

TIAN Lin, Email: 50273414@qq.com

Keywords：

Diabetic foot; wound infection; nose ring drain

DOI：

10.7507/1002-1892.202003190

Video：

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Objective To evaluate the effectiveness of the nose ring drain (NRD) in treatment of severe diabetic foot infection.Methods The clinical data of 35 patients with severe diabetic foot infection who were treated with NRD between June 2017 and June 2019 were analyzed retrospectively. There were 24 males and 11 females with an average age of 54.5 years (range, 28-82 years). All of them were type 2 diabetic patients. The diabetes duration was 3-20 years, with an average of 9.4 years. The diabetic foot duration was 4 months to 2 years, with an average of 1.16 years. There were 16 cases of left foot and 19 cases of right foot. According to Wagner’s grading, there were 11 cases of grade 2, 20 cases of grade 3, and 4 cases of grade 4, all of which were moderate and severe infection of diabetic foot wound. Postoperative wounds were treated with “nibble-like” debridement until the patient’s epidermis regenerated and healed. During the treatment process, the indexes of bacterial culture type of wound secretions, duration of antibiotic therapy, wound healing method, healing time, amputation rate, and other indicators were analyzed and summarized.Results All 35 patients were followed up 3-6 months, with an average of 4.5 months. Postoperative bacterial culture of wounds showed that 5 cases of Staphylococcus aureus, 4 cases of Pseudomonas aeruginosa, 5 cases of Escherichia coli, 3 cases of Enterobacter cloacae, 3 cases of coagulase-negative Staphylococcus, and 15 cases of other types were detected. The duration of antibiotic therapy ranged from 3 to 15 days, with an average of 9.1 days. The wound was autolytically healed without skin grafting, and the healing time was 62-82 days, with an average of 72.3 days. During the follow-up, 3 cases (8.6%) had amputation due to the patient’s poor blood glucose control, which led to a large spread of infection. In addition, among the other patients with wound healing, there was no recurrence of wound infection or new ulcer on the original surface.Conclusion The NRD is a simple operation for treatment of severe diabetic foot infection, which can effectively control wound infections and promote wound healing and regeneration without skin grafting.

Citation： TIAN Lin, Aikebaier·Yasen, TAN Yuzhong, LI Faxiang, GAO Bo, CHENG Liangkun, HE Dong, QU Long. Clinical application of nose ring drain in severe diabetic foot infection. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(8): 990-993. doi: 10.7507/1002-1892.202003190 Copy

1.	李宏燁, 尤加省, 劉超, 等. 脛骨橫向骨搬運術治療糖尿病足潰瘍的療效. 中國修復重建外科雜志, 2019, 33(1): 23-27.
2.	孫權. 負壓封閉引流技術治療糖尿病足潰瘍的臨床效果. 臨床合理用藥雜志, 2019, 12(6): 134-135.
3.	Qu L, Du ZH, Wei ZY, et al. Effective treatment of external fixation with NRD for difficult bone infection. The Journal of the Japanese Association of External Fixation and Limb Lengthening, 2013, 24: 133.
4.	谷涌泉. 中國糖尿病足診治指南. 中國臨床醫生雜志, 2020, 48(1): 19-26.
5.	中華醫學會糖尿病學分會, 中華醫學會感染病學分會, 中華醫學會組織修復與再生分會. 中國糖尿病足防治指南 (2019版)(Ⅰ). 中華糖尿病雜志, 2019, 11(2): 92-108.
6.	曲龍. 骨搬移治療骨缺損與骨不連 Ilizarov 技術的臨床應用. 2版. 北京: 人民衛生出版社, 2009: 8.
7.	馬敬第, 黃冬梅, 徐明喜, 等. 牛鼻子對口引流和逐步清創在糖尿病足潰瘍保肢中的應用. 臨床醫藥文獻電子雜志, 2019, 6(29): 13, 16.
8.	Takei T, Danjo S, Sakoguchi S, et al. Autoclavable physically-crosslinked chitosan cryogel as a wound dressing. J Biosci Bioeng, 2018, 125(4): 490-495.
9.	Hodgson H, Davidson D, Duncan A, et al. Clinical evaluation of a hydro-responsive wound dressing: the Glasgow experience. J Wound Care, 2017, 26(11): 642-650.
10.	Jo?o Guilherme B De Marchi, Denise S Jornada, Fernanda K Silva, et al. Triclosan resistance reversion by encapsulation in chitosan-coated-nanocapsule containing α-bisabolol as core: development of wound dressing. Int J Nanomedicine, 2017, 12: 7855-7868.
11.	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.
12.	王江寧, 高磊. 糖尿病足慢性創面治療的新進展. 中國修復重建外科雜志, 2018, 32(7): 832-837.
13.	Blume PA, Donegan R, Schmidt BM. The role of plastic surgery for soft tissue coverage of the diabetic foot and ankle. Clin Podiatr Med Surg, 2014, 31(1): 127-150.
14.	Hasan MY, Teo R, Nather A. Negative-pressure wound therapy for management of diabetic foot wounds: a review of the mechanism of action, clinical applications, and recent developments. Diabetic Foot & Ankle, 2015, 6(1): 27618.
15.	Li P, Ning XH, Jia L, et al. A minimally invasive incision and loop drainage technique for the treatment of lower limb Morel-Lavallée lesions: nose ring drainage technique. Injury, 2020, 51(2): 570-573.

1. 李宏燁, 尤加省, 劉超, 等. 脛骨橫向骨搬運術治療糖尿病足潰瘍的療效. 中國修復重建外科雜志, 2019, 33(1): 23-27.
2. 孫權. 負壓封閉引流技術治療糖尿病足潰瘍的臨床效果. 臨床合理用藥雜志, 2019, 12(6): 134-135.
3. Qu L, Du ZH, Wei ZY, et al. Effective treatment of external fixation with NRD for difficult bone infection. The Journal of the Japanese Association of External Fixation and Limb Lengthening, 2013, 24: 133.
4. 谷涌泉. 中國糖尿病足診治指南. 中國臨床醫生雜志, 2020, 48(1): 19-26.
5. 中華醫學會糖尿病學分會, 中華醫學會感染病學分會, 中華醫學會組織修復與再生分會. 中國糖尿病足防治指南 (2019版)(Ⅰ). 中華糖尿病雜志, 2019, 11(2): 92-108.
6. 曲龍. 骨搬移治療骨缺損與骨不連 Ilizarov 技術的臨床應用. 2版. 北京: 人民衛生出版社, 2009: 8.
7. 馬敬第, 黃冬梅, 徐明喜, 等. 牛鼻子對口引流和逐步清創在糖尿病足潰瘍保肢中的應用. 臨床醫藥文獻電子雜志, 2019, 6(29): 13, 16.
8. Takei T, Danjo S, Sakoguchi S, et al. Autoclavable physically-crosslinked chitosan cryogel as a wound dressing. J Biosci Bioeng, 2018, 125(4): 490-495.
9. Hodgson H, Davidson D, Duncan A, et al. Clinical evaluation of a hydro-responsive wound dressing: the Glasgow experience. J Wound Care, 2017, 26(11): 642-650.
10. Jo?o Guilherme B De Marchi, Denise S Jornada, Fernanda K Silva, et al. Triclosan resistance reversion by encapsulation in chitosan-coated-nanocapsule containing α-bisabolol as core: development of wound dressing. Int J Nanomedicine, 2017, 12: 7855-7868.
11. 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.
12. 王江寧, 高磊. 糖尿病足慢性創面治療的新進展. 中國修復重建外科雜志, 2018, 32(7): 832-837.
13. Blume PA, Donegan R, Schmidt BM. The role of plastic surgery for soft tissue coverage of the diabetic foot and ankle. Clin Podiatr Med Surg, 2014, 31(1): 127-150.
14. Hasan MY, Teo R, Nather A. Negative-pressure wound therapy for management of diabetic foot wounds: a review of the mechanism of action, clinical applications, and recent developments. Diabetic Foot & Ankle, 2015, 6(1): 27618.
15. Li P, Ning XH, Jia L, et al. A minimally invasive incision and loop drainage technique for the treatment of lower limb Morel-Lavallée lesions: nose ring drainage technique. Injury, 2020, 51(2): 570-573.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of nose ring drain in severe diabetic foot infection

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