Objective To review the progress in amputation technique of diabetic foot. Methods Recent l iterature concerning the amputation technique of diabetic foot was reviewed and analyzed. Results According to the different levels of the amputation, the diabetic foot’s amputation can be classified as major amputation and minor amputation, and differentkinds of methods can derive from these styles. Different factors should be considered when the style and method of amputation are chosen. Conclusion To the diabetic foot amputation, the general rule is to l imit the amputation level on the premise of the good cl inical effect. The health state, the region of the diabetic foot, the tissue perfusion, the susceptibil ity to infection in local tissue, and the abil ity of wound healing are important factors in selecting the styles and methods of diabetes-related amputations. Importance should be attached to the synthesis treatments of diabetes to prevent the higher level amputation.
ObjectiveTo systematically review the methodological quality of Chinese clinical practice guidelines (CPGs) for diagnosis and management of diabetic foot.MethodsCNKI, WanFang Data, VIP, CBM, Yimaitong databases, website of Diabetes Branch of Chinese Medical Association, website of Chinese Integrative Medicine Association and website of Peripheral Vascular Disease Professional Committee of Chinese Society of Microcirculation were electronically searched to collect relevant CPGs from inception to May, 2020. Four researchers independently evaluated the CPGs methodological quality by using AGREEⅡ tool.ResultsA total of 10 Chinese CPGs for diabetes foot were included. The standardized mean scores for various fields were 75.74% for scope and purpose, 36.58% for stakeholder involvement, 28.61% for rigor of development, 86.30% for clarity and presentation, 43.47% for applicability, and 9.44% for editorial independence. ConclusionsThere are merely a small quantity of diabetic foot guidelines in China, and the methodological quality is insufficient. Therefore, more attention should be focused on the establishment of guidelines in the future, so as to further improve the quality of Chinese diabetic foot guidelines.
ObjectiveTo understand the status of life quality and fatigue level in patients with diabetic foot and to explore its influencing factors. MethodsRandom sampling method was used in collecting the general data of 80 diabetic foot patients from January 2013 to January 2014. The questionnaire of Fatigue Scale-14 and Diabetes Specific Quality of Life Scale were analyzed, and the influencing factors of fatigue and life quality were investigated. ResultsThe total score mean value of fatigue was 8.63±3.39 and the total score mean value of life quality was 71.00±19.84. The life quality and fatigue in patients with diabetic foot were positively correlated (P ＜ 0.01) . ConclusionsThe life quality of patients needs to be improved. We should especially pay attention to their mental health and try to meet their psychological needs, in order to ease the patients’ fatigue level and improve their life quality. The key for diabetic foot nursing is to discover and assess the fatigue symptoms of patients with diabetic foot diseases.
【摘要】 目的 觀察透明質酸鋅凝膠治療糖尿病足創面的療效。 方法 2009年6月—2010年6月收治60例創面面積≤6 cm2的糖尿病足患者，其中男41例，女19例；年齡 49～80歲，平均58歲。糖尿病病程4～20年，糖尿病足病程2～12周。按照糖尿病足Wagner分級標準進行分級為Ⅰ、Ⅱ、Ⅲ級（每級各20例）。將患者隨機分為治療組和對照組，每組30例，每級各10例。兩組患者性別、年齡、病程及創面比較差異均無統計學意義（Pgt;0.05），具有可比性。兩組患者均常規給予胰島素或降糖藥控制血糖，并同時給予抗炎、改善微循環及營養支持治療。處理上治療組加用透明質酸鋅凝膠，對照組僅常規換藥，治療后4、8周觀察兩組創面愈合情況。 結果 治療組8周時治愈率為53.3%，總有效率為96.7%；對照組治愈率為30.0%，總有效率為60.0%；兩組總有效率比較差異有統計學意義（Plt;0.05）。治療組對于Ⅱ、Ⅲ級創面的治愈率和有效率均明顯優于對照組（Plt;0.01）。治療組創面愈合時間為（23.25±8.52） d，對照組為（29.16±9.20） d，差異有統計學意義（Plt;0.05）。兩組治療后細菌培養結果無明顯差異。 結論 透明質酸鋅凝膠制劑應用于糖尿病足的創面治療，能起到保護創面和促進創面愈合的作用，為治療糖尿病足創面提供了一種新的方法。【Abstract】 Objective To explore the curative effect of zinc hyaluronate in the treatment of diabetic foot wound. Methods Sixty patients with a diabetic foot wound area ≤6 cm2 were treated in our hospital from June 2009 to June 2010. There were 41 males and 19 females with their ages ranged from 49 to 80 years old, averaging at 58. The course of diabetes ranged from 4 to 20 years, and diabetic foot 2 to 12 weeks. According to diabetic foot Wagner grading standards, the patients were classified as grade Ⅰ, Ⅱ and Ⅲ (with 20 patients for each grade). They were randomly divided into the treatment group and the control group with 30 patients in each group and for both groups, there were 10 patients for each Wagner grade. There were no statistically significant differences between the two groups of patients in gender, age, duration of the disease course, and wound area (Pgt;0.05) so that they were comparable. All patients were routinely offered with insulin or other medicine to control blood sugar level, and at the same time they accepted anti-inflammatory, microcirculation improving and nutrition supporting treatments. Zinc hyaluronate was added to the treatment of the patients in the treatment group, while the control group underwent conventional treatment. Wound healing condition was observed 4 and 8 weeks after the beginning of the treatment. Results At week eight, the cure rate for the treatment group was 53.3%, and the total effective rate was 96.7%; the two numbers for the control group were respectively 30.0% and 60.0%. There was a significant difference between the two groups in the total effectiveness (Plt;0.05). The cure rate and total effective rate for grade Ⅱ and Ⅲ wound in the treatment group were better than those in the control group (Plt;0.01). Coagulant time for the treatment group and the control group was respectively (23.25±8.52) days and (29.16±9.20) days with a significant difference (Plt;0.05). No statistical difference was found in the bacteria cultures between the two groups after treatment. Conclusions Using zinc hyaluronate in diabetic foot treatment can obviously protect the wound and promote wound healing. It is a good choice for diabetic foot wound healing.
ObjectiveTo investigate the effect of transverse tibial bone transport on the expression of angiogenesis-related growth factors in the serum of diabetic foot patients.MethodsBetween January 2018 and December 2018, 10 patients who suffered from diabetes mellitus accompanied with Wagner stage 4 diabetic foot underwent transverse tibial bone transport. There were 5 males and 5 females with an average age of 59.2 years (range, 51-70 years). The duration of diabetes was 2-60 months, with an average of 24.2 months. The duration of diabetic foot was 30-120 days, with an average of 54.1 days. Peripheral venous blood was taken at 1 day before operation and at 1, 4, 11, 18, 28, and 35 days after operation. The serum was centrifuged and subjected to ELISA test to detect the expression levels of serum vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), epidermal growth factor (EGF), and platelet-derived growth factor (PDGF).ResultsThe levels of serum VEGF, bFGF, and EGF increased rapidly at 11 days after operation, and the expression levels of the factors at 11, 18, 28, and 35 days were significantly higher than those before operation (P<0.05). The expression level of PDGF increased suddenly at 18 days after operation, and the expression level of PDGF at 18, 28, and 35 days was significantly higher than that before operation (P<0.05).ConclusionTransverse tibial bone transport for the treatment of diabetic foot can significantly increase the expression of serum angiogenesis-related growth factors in early stage, which may be the mechanism of promoting the healing of diabetic foot wounds.
Objective The self-defined multidisciplinary (endocrinology, vascular surgery, and orthopedics) scoring system (EMO scoring system for short) was designed. The feasibility of the EMO scoring system to guide the proximal tibial transverse transport (TTT) for diabetic foot wounds was preliminarily explored. Methods Based on the current commonly used clinical criteria for diabetic foot judgment, expert consensus, guidelines, and related research progress in the treatment of diabetic foot wounds, combined with clinical experience, a set of EMO scoring systems including endocrinology, vascular surgery, and orthopedics was formulated. The criteria for selecting conservative treatment, TTT after baseline improvement, and TTT based on scoring results was proposed. A total of 56 patients with diabetic foot wounds who were admitted between September 2017 and July 2022 and met the selection criteria was taken as the study subjects. Among them, 28 patients were treated with TTT and 28 patients were treated conservatively. The patients were graded according to the EMO scoring system, the corresponding treatment methods were selected, and the actual treatment methods and results of the patients were compared. Results The EMO scoring system was formed through literature retrieval and clinical experiences. The system included three criteria, namely endocrinology (E), macrovascular disease (M), and orthopedics (O), which were divided into multiple subtypes according to the relevant evaluation items, and finally the diabetic foot wound was divided into 8 types, which correspondingly selected TTT, TTT after baseline improvement, and conservative treatment. All 56 patients were followed up 12 months after treatment. Among them, the wound healing rate of the TTT group was 85.71% (24/28), which was higher than that of the conservative treatment group [53.57% (15/28)]. At 12 week after treatment, CT angiography showed that there were more small blood vessels in the wound and ipsilateral limb in TTT group than in the conservative treatment group. Based on the EMO scoring system, 14 of the 56 patients needed conservative treatment, 29 patients needed TTT, and 13 patients needed TTT after baseline improvement. Compared with the clinical data of the patients, the wound healing rate of the patients judged to be TTT was 75.86% (22/29), of which 21 cases were actually treated with TTT, and the healing rate was 90.48%; 8 patients were treated conservatively, and the healing rate was 37.50%. The wound healing rate of the patients judged to be conservative treatment was 92.86% (13/14), of which 1 case was actually treated with TTT, and the healing rate was 100%; 13 cases were treated conservatively, and the healing rate was 92.31%; 1 case experienced minor amputation. The wound healing rate of the patients judged to TTT after baseline improvement was only 30.77% (4/13), of which 6 cases were actually treated with TTT, and the healing rate was 66.67%; 7 cases were treated conservatively, and the healing rate was 0. Conclusion EMO scoring system can comprehensively evaluate the diabetic foot wounds, and make personalized judgment on whether TTT treatment is feasible, so as to improve the level of diabetic foot wound treatment and the prognosis of patients.
The annual incidence of diabetic foot ulcers in China is as high as 8.1%, which ranks first among the causes of chronic wounds in China. Although through the efforts of several generations of podiatrists and the building of multidisciplinary collaboration team, the major amputation rate in patients with diabetic foot ulcers in China has been decreased significantly, it is still far higher than the level of developed countries in Europe and the United States. Therefore, in order to cope with the increasing occurrence and recurrence of refractory diabetic foot ulcers, in addition to further optimizing the construction of multidisciplinary collaboration team, it is an urgent topic for us to explore the construction of a multidisciplinary integrated team to seamlessly connect the diagnosis and treatment of different aspects of foot disease. This article describes the importance and necessity of building a wound repair center with Chinese characteristics, which is a model of multidisciplinary integrated team, aiming at provide a theoretical basis for establishing a multidisciplinary integrated management model and realizing seamless connection between diagnosis and treatment, so as to further improve the cure rate of diabetic foot ulcers.
Diabetic foot ulcer is the most serious complication of diabetes. In addition to diabetic peripheral neuropathy and lower extremity vascular disease, diabetic foot pressure abnormality is an independent risk factor for diabetic foot ulcers. This review summarizes the relationship between plantar pressure and diabetes, including the concept of the plantar pressure and its measurement methods, as well as the abnormal changes in the plantar pressure of diabetic patients. In addition, through the explanation of the mechanism of diabetic patients’ plantar pressure changes, the methods of releasing the abnormal plantar pressure are discussed, so as to prevent and treat the diabetic foot ulcers, and improve our understanding of it.
To investigate the surgical strategy of diabetic foot (DF) and analyze the therapeutic efficacy. Methods From July 2004 to July 2007, 36 patients (22 males and 14 females) with DF were treated, with an average age of 57 years(43-82 years). The disease course of diabetes was 3 months to 27 years(12 years on average) and the disease course of DF was 1 month to 2 years (7 months on average). According to Wagner classification of DF, there were 3 cases of grade 1, 12 cases of grade 2, 10 cases of grade 3, 7 cases of grade 4 and 4 cases of grade 5. The locations of ulcer were ankle and heel in 9 cases, medial part of foot in 14 cases, in lateral part of foot in 8 cases and sinus formation in 5 cases. The ulcer sizes ranged from 4 cm × 2 cm-18 cm × 9 cm. Initial management of these patients included control of blood sugar level, proper hydration, administration of antibiotics, treatment of coexisting diseases, and repeated debridements of wounds when necessary. Ulcers were treated with debridement and spl it skin transplantation in 3 cases of grade 1, with debridement and drainage of abcesses and spl it skin transplantation in 12 of grade 2, with debridement and transplantation of flap in 17 of grade 3 and grade 4, and with transplantation of fascial flap in 5 cases of sinus; ulcers were treated firstly with artery bypass of lower extremity, and then treated with local amputation of foot to avoid high-level amputation and to save more function of foot in 4 of grade 5. Results In 36 cases, wound in 31 cases (86.1%) cured primaryly, wound did not heal in 1 patient (2.1%) and received re-amputation, there were 2 deaths because of infection with multiple organ failure postoperatively. Twenty-nine cases were followed up 8 months (range, 6 -15 months). Eight patients developed new ulcers, with 3 lesions in situ and 5 lesions in new site. Conclusion Surgicalregimen could play an important role in treatment of diabetic foot. According to different grades of DF, there were differentstrategies in deal ing with the accompanied inflammation and ulcer. An active and comprehensive surgical treatment of DF could save the foot, avoid the high-level amputation and result in more functional extremity.
Objective To investigate the effectiveness of free anterolateral thigh flap (ALTF) with fascia lata in repairing diabetic foot ulcers (DFUs) with bone exposure. Methods Between January 2019 and January 2021, 20 patients with DFUs with bone exposure were admitted. There were 17 males and 3 females with a median age of 57.5 years (range, 48-76 years). There were 10 cases of Wagner grade 3 and 10 cases of grade 4. The DFUs formed 1 to 14 months, with a median time of 3 months. The patients underwent CT angiography, which showed extensive atherosclerosis in both lower limbs; 6 of them were severely narrowed or occluded and underwent percutaneous transluminal angioplasty. The size of wound ranged from 7 cm×6 cm to 27 cm×10 cm after applied first-stage debridement combined with vacuum sealing drainage treatment. In the second-stage, free ALTF with fascia lata was used to repair wounds and partial defects of tendons. The size of flap ranged from 8 cm×5 cm to 28 cm×11 cm. The wound of the donor site was sutured directly. The survival of the flap, the healing time of the wound, and the complications were recorded. The laser speckle blood flow imaging system was used to detect the blood perfusion of the flap and the skin around the flap at 2 weeks and 6 months after operation. The foot function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score at 6 months after operation. Results After operation, effusion under the flap happened in 6 cases, which cured after symptomatic treatment. Flaps survived completely in 14 cases. The tissue necrosis at the edges of the flaps occurred in 3 cases and healed after dressing changes. Venous crisis of flaps occurred in 3 cases, of which 1 case was completely necrotic after exploration, and the other 2 cases were partially alive. The wounds of 3 cases were repaired with skin grafts after debridement and dressing. The flap survival rate was 95.0%, and the limb salvage rate was 100%. The wound healing time after flap transplantation was 14-30 days, with an average of 19.1 days. Two patients had recurrence of peripheral skin ulcers of the flaps within 1 month after healing, which healed after conservative dressing changes. Eighteen cases of incisions at donor site healed by first intention, 2 cases had local skin necrosis and healed by debridement and suture. All patients were followed up 6-30 months, with a median time of 11 months. The texture, appearance, and elasticity of the flaps were good. All patients could walk alone without pain. At 6 months after operation, the AOFAS score was 75.9±11.9, which was significantly different from that (44.7±18.4) before operation (t=?7.025, P=0.000). The blood perfusion value increased from (38.1±7.8) PU at 2 weeks to (42.7±10.3) PU, and the difference was significant (t=?4.680, P=0.001). Conclusion Free ALTF with fascia lata has a rich blood supply and a high survival rate. It can be used to repair DFUs with bone exposure. After the free skin flap healed, it can promote revascularization of the affected foot, reduce the probability of ulcer recurrence, and avoid amputation.