Treatment of severe diabetic foot ulcer using tibia transverse transport combined with nose ring drain_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YU Jie ¹ , HUA Qikai ^1,2 , KUANG Xiaocong ³ , LIU Jie ⁴ , LIU Guangwei ^1,5 , LI Shanlang ^4,5 , NIE Xinyu ^4,5 , SU Hongjie ^4,5 , DING Yi ¹ , ZHONG Zhaowei ¹ , YANG Jiangtao ¹ , HE Liexun ¹ ,  CHEN Yan ¹

1. Department of Bone and Joint Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021, P.R.China;
2. Guangxi Diabetic Foot Salvage Engineering Research Center, Nanning Guangxi, 530021, P.R.China;
3. School of Basic Medicine, Guangxi Medical University, Nanning Guangxi, 530021, P.R.China;
4. Guangxi Collaborative Innovation Center of Biomedicine, Nanning Guangxi, 530021, P.R.China;
5. Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning Guangxi, 530021, P.R.China;

Corresponding?author：

CHEN Yan, Email: cy003@connect.hku.hk

Keywords：

Diabetic foot; ulcer; tibia transverse transport; nose ring drain

DOI：

10.7507/1002-1892.202103039

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Objective To investigate the effectiveness of tibial transverse transport (TTT) combined with nose ring drain (NRD) in the treatment of severe diabetic foot ulcer.Methods The clinical data of 60 patients with severe diabetic foot (Wagner grade 3 or 4) ulcer who were admitted between April 2017 and August 2020 and met the selection criteria were retrospectively analyzed. Among them, 30 cases were treated with TTT combined with NRD (TTT+NRD group), and 30 cases were treated with TTT (TTT group). There was no significant difference in gender, age, diabetes duration, preoperative glycated hemoglobin, comorbidities, wound area, and duration, side, and grade of diabetic foot (P>0.05). The wound healing time, wound healing rate, amputation rate, recurrence rate, duration of antibiotic therapy, hospital stay, number of hospitalizations, and number of operations were recoreded and compared between the two groups.Results No obvious surgical complications occurred in the two groups. Patients in both groups were followed up 3-13 months, with an average of 5.7 months. The duration of antibiotic therapy and hospital stay in the TTT+NRD group were significantly shorter than those in the TTT group (P<0.05). There was no significant difference in wound healing time, wound healing rate, number of hospitalizations, and number of operations between the two groups (P>0.05). During follow-up, there was no recurrence of ulcer in the TTT+NRD group while 2 recurrent cases (6.7%) in the TTT group. The difference in recurrence rate was not significant (P=0.492). One case (3.3%) in the TTT+NRD group underwent amputation due to acute lower extremity vascular embolism, and 1 case (3.3%) in the TTT group underwent amputation due to secondary necrosis. The difference in amputation rate was not significant between the two groups (P=1.000).Conclusion TTT combined with NRD is an effective method for the treatment of severe diabetic foot ulcers with deep infections or relatively closed cavities or sinuses. It can shorten the time of antibiotic use and the length of hospitalization; and the NRD has a good drainage effect without obvious comorbidities, procedure and the postoperative care are simple and easy to obtain materials.

Citation： YU Jie, HUA Qikai, KUANG Xiaocong, LIU Jie, LIU Guangwei, LI Shanlang, NIE Xinyu, SU Hongjie, DING Yi, ZHONG Zhaowei, YANG Jiangtao, HE Liexun, CHEN Yan. Treatment of severe diabetic foot ulcer using tibia transverse transport combined with nose ring drain. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(8): 984-988. doi: 10.7507/1002-1892.202103039 Copy

1.	Jiang Y, Wang X, Xia L, et al. A cohort study of diabetic patients and diabetic foot ulceration patients in China. Wound Repair Regen, 2015, 23(2): 222-230.
2.	Cho NH, Shaw JE, Karuranga S, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract, 2018, 138: 271-281.
3.	中國醫療保健國際交流促進會糖尿病足病分會. 中國糖尿病足診治指南. 中華醫學雜志, 2017, 97(4): 251-258.
4.	張定偉, 秦泗河, 臧建成. Ilizarov微循環重建技術治療Wagner4級糖尿病足臨床療效分析. 中國矯形外科雜志, 2017, 25(4): 354-356.
5.	歐栓機, 齊勇, 孫鴻濤, 等. 經皮微創脛骨截骨橫向骨搬移術治療糖尿病足. 中國矯形外科雜志, 2018, 26(15): 1385-1389.
6.	王林華, 周富強, 盧敏, 等. 應用Ilizarov橫向骨搬移技術微創截骨治療糖尿病足13例. 中國中醫骨傷科雜志, 2018, 26(11): 42-45.
7.	花奇凱, 秦泗河, 趙良軍, 等. Ilizarov技術脛骨橫向骨搬移術治療糖尿病足. 中國矯形外科雜志, 2017, 25(4): 303-307.
8.	Chen Y, Kuang X, Zhou J, et al. Proximal tibial cortex transverse distraction facilitating healing and limb salvage in severe and recalcitrant diabetic foot ulcers. Clin Orthop Relat Res, 2020, 478(4): 836-851.
9.	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. Diabet Foot Ankle, 2015, 6: 27618. doi: 10.3402/dfa.v6.27618.
10.	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.
11.	曲龍. 骨搬移治療骨缺損與骨不連-Ilizarov技術的臨床應用. 北京: 人民衛生出版社, 2009: 44-48.
12.	張平榮, 任靜, 孫嶸, 等. 牛鼻子引流術在感染性傷口治療中的應用. 中國骨與關節損傷雜志, 2018, 33(7): 780-781.
13.	Wagner FW. The dysvascular foot: a system for diagnosis and treatment. Foot Ankle, 1981, 2(2): 64-122.
14.	何立環, 陳炎, 鄺曉聰, 等. 重度糖尿病足脛骨橫向骨搬移術治療后創面愈合規律分析. 中醫正骨, 2019, 31(10): 790-793.
15.	Nie X, Kuang X, Liu G, et al. Tibial cortex transverse transport facilitating healing in patients with recalcitrant non-diabetic leg ulcers. J Orthop Translat, 2020, 27: 1-7.
16.	高偉, 林震迅, 鎮普祥, 等. 脛骨橫向骨搬移后巨噬細胞促進重度糖尿病足創面的愈合. 中國組織工程研究, 2018, 22(36): 5811-5815.
17.	Li P, Ning X, 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.
18.	馬敬弟, 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.
19.	田林, 譚玉忠, 李發祥, 等. 牛鼻子引流術在嚴重糖尿病足感染創面中的臨床應用. 中國修復重建外科雜志, 2020, 34(8): 990-993.

1. Jiang Y, Wang X, Xia L, et al. A cohort study of diabetic patients and diabetic foot ulceration patients in China. Wound Repair Regen, 2015, 23(2): 222-230.
2. Cho NH, Shaw JE, Karuranga S, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract, 2018, 138: 271-281.
3. 中國醫療保健國際交流促進會糖尿病足病分會. 中國糖尿病足診治指南. 中華醫學雜志, 2017, 97(4): 251-258.
4. 張定偉, 秦泗河, 臧建成. Ilizarov微循環重建技術治療Wagner4級糖尿病足臨床療效分析. 中國矯形外科雜志, 2017, 25(4): 354-356.
5. 歐栓機, 齊勇, 孫鴻濤, 等. 經皮微創脛骨截骨橫向骨搬移術治療糖尿病足. 中國矯形外科雜志, 2018, 26(15): 1385-1389.
6. 王林華, 周富強, 盧敏, 等. 應用Ilizarov橫向骨搬移技術微創截骨治療糖尿病足13例. 中國中醫骨傷科雜志, 2018, 26(11): 42-45.
7. 花奇凱, 秦泗河, 趙良軍, 等. Ilizarov技術脛骨橫向骨搬移術治療糖尿病足. 中國矯形外科雜志, 2017, 25(4): 303-307.
8. Chen Y, Kuang X, Zhou J, et al. Proximal tibial cortex transverse distraction facilitating healing and limb salvage in severe and recalcitrant diabetic foot ulcers. Clin Orthop Relat Res, 2020, 478(4): 836-851.
9. 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. Diabet Foot Ankle, 2015, 6: 27618. doi: 10.3402/dfa.v6.27618.
10. 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.
11. 曲龍. 骨搬移治療骨缺損與骨不連-Ilizarov技術的臨床應用. 北京: 人民衛生出版社, 2009: 44-48.
12. 張平榮, 任靜, 孫嶸, 等. 牛鼻子引流術在感染性傷口治療中的應用. 中國骨與關節損傷雜志, 2018, 33(7): 780-781.
13. Wagner FW. The dysvascular foot: a system for diagnosis and treatment. Foot Ankle, 1981, 2(2): 64-122.
14. 何立環, 陳炎, 鄺曉聰, 等. 重度糖尿病足脛骨橫向骨搬移術治療后創面愈合規律分析. 中醫正骨, 2019, 31(10): 790-793.
15. Nie X, Kuang X, Liu G, et al. Tibial cortex transverse transport facilitating healing in patients with recalcitrant non-diabetic leg ulcers. J Orthop Translat, 2020, 27: 1-7.
16. 高偉, 林震迅, 鎮普祥, 等. 脛骨橫向骨搬移后巨噬細胞促進重度糖尿病足創面的愈合. 中國組織工程研究, 2018, 22(36): 5811-5815.
17. Li P, Ning X, 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.
18. 馬敬弟, 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.
19. 田林, 譚玉忠, 李發祥, 等. 牛鼻子引流術在嚴重糖尿病足感染創面中的臨床應用. 中國修復重建外科雜志, 2020, 34(8): 990-993.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of severe diabetic foot ulcer using tibia transverse transport combined with nose ring drain

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