Diabetic foot ulcer (DFU) is one of the most serious complications of diabetes mellitus. Considering complicated conditions, poor general condition, severe infection and poor outcomes as the feature characteristics of Chinese DFU patients, comprehensive and systematic evaluation, including general condition, region of the foot, and psychological status, is essential and fundamental for successful treatment. This commentary summarizes the evaluation contents in scientific and standardized diagnosis and treatment of diabetic foot ulcer, and looking forward to reducing morbidity, recurrence rate and mortality, and increasing limb salvage rate.
ObjectiveTo systematically evaluate the effects of nine different dressings in the treatment of diabetic foot (DF). MethodsDatabases including PubMed, The Cochrane Library (Issue 2, 2016), Web of Science, EMbase, CBM, CNKI and WanFang Data were searched to collect randomized control trials (RCTs) about the effects of dressings for the DF from inception to April 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then network meta-analysis was performed using WinBugs 1.4.3 and Stata 13.0 softwares. ResultsA total of 29 RCTs involving 2 393 patients were included. The network meta-analysis showed that silver ion was superior to alginate, hydrogel, honey, sterile gauze and povidone-iodine gauze; Alginate was superior to sterile gauze and povidone-iodine gauze; Hydrogel was superior to povidone-iodine gauze; Honey was superior to sterile gauze and povidone-iodine gauze; Foam was superior to silver ion, alginate, hydrogel, honey, sterile gauze, povidone-iodine gauze and antibacterials gauze; Chitosan was superior to hydrogel, sterile gauze and povidone-iodine gauze; Antibacterials gauze was superior to sterile gauze and povidone-iodine gauze. All of the differences were statistically significant. Probability ranking according to SUCRA showed that there was a great possibility for foam and chitosan in the treatment of DF. ConclusionBased on the results of network meta-analysis and rank, foam dressing and chitosan dressing are superior to other dressings in the treatment of DF. More attentions should be made regarding comparisons directly of different dressing and reporting of cost-effective analysis.
ObjectiveTo explore the relationship of the level of inflammation and nutritional status with the occurrence and prognosis of refractory diabetic foot.MethodsA total of 70 patients with refractory diabetic foot between August 2015 and August 2017 were randomly selected as the observation group. Another 70 patients with diabetes mellitus (without foot ulcer) who visited the hospital in the same period were set as the control group. The observation group was subgrouped into the non-amputation group and the amputation group according to the follow-up endpoint events, and into the grade Ⅲ, Ⅳ, and Ⅴ groups according to Wagner classification method. The blood levels of inflammatory markers and nutritional markers between groups were compared.ResultsIn the observation group, vascular cell adhesion molecule-1 (VCAM-1), fibroblast growth factor 2 (FGF2), fibrinogen (FIB), tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-18, lipoprotein phospholipase A2 (LP-PLA2), C-reactive protein (CRP) levels were significantly higher than those in the control group, and albumin (ALB), prealbumin (PA), and transferrin (TRF) levels were significantly lower than those in the control group, with statistically significant differences (P<0.01). The blood levels of FGF2, FIB, IL-6, IL-18, LP-PLA2, and CRP in the amputation group were significantly higher than those in the non-amputation group, and the levels of TRF, ALB, and PA were significantly lower than those in the non-amputation group (P<0.01). There were statistically significant differences in the levels of FGF2, FIB, IL-6, IL-18, LP-PLA2, CRP, TRF, ALB, and PA in patients with diabetic foot with different Wagner grades (P<0.05). The result of multiple logistic regression analysis showed that IL-6 [odds ratio (OR)=1.487, 95% confidence interval (CI) (1.023, 2.120), P<0.001], IL-18 [OR=1.274, 95%CI (1.052, 1.665), P<0.001], LP-PLA2 [OR=1.478, 95%CI (1.126, 1.789), P<0.001], and CRP [OR=2.085, 95%CI (1.574, 2.782), P<0.001] were independent risk factors for the occurrence of refractory diabetic foot, and TRF [OR=0.645, 95%CI (0.002, 0.898), P<0.001], ALB [OR=0.838, 95%CI (0.429, 0.923), P<0.001], and PA [OR=0.478, 95%CI (0.201, 0.984), P<0.001] were independent protective factors for the occurrence of refractory diabetic foot.ConclusionIn the clinical treatment of diabetic foot, we should pay attention to the monitoring of the level of inflammatory factors and nutritional status, and it is necessary to timely carry out anti-inflammatory treatment and appropriate nutritional support treatment.
Objective To determine the effectiveness and safety of autologous platelet-rich gel in the management of diabetic foot ulcer. Methods We searched Cochrane Central Register of Controlled Trails (CENTRAL), MEDLINE or PubMed, EMbase, OVID Database, Chinese Biological Medicine Database (CBMDisc), CNKI, Chinese VIP Database and WANFANG Database. We also handsearched the bibliographies of retrieved articles and correlated proceedings. The systematic review was conducted using the method recommended by the Cochrane Collaboration. Results Four trials involving 216 patients were included. Meta-analyses showed (1) Diabetic foot ulcer healing rate: Autologous platelet-rich gel was superior to the standard care (Plt;0.000 01); (2) Diabetic foot ulcer reduction rate: Autologous platelet-rich gel was superior to the standard care (P=0.000 3); (3) Diabetic foot ulcer healing time: Autologous platelet-rich gel was superior to the standard care (Plt;0.000 01); (4) Complications: No patient in these trials had complications. Conclusions The limited current evidence shows that autologous platelet-rich gel is safe and effective in the short-term treatment for diabetic foot ulcer.
ObjectiveTo investigate the clinical therapeutic effect of silver ions dressing for patient with diabetic foot ulcers. MethodsAccording to the diagnostic and classification criteria of diabetes and diabetic foot of World Health Organization (WHO), outpatients and inpatients with diabetic foot ulcers admitted to the Department of Burns and Plastic Surgery of Dazhou Central Hospital from October 2013 to May 2015 were randomly divided into a silver ion dressing treatment group and a traditional dressing treatment group. The effective rate, time of occurrence of granulation tissue, wound healing time and wound area reduction ratio between the two groups were compared by using SPSS17.0 software. ResultsA total of 80 patients were included, of which 40 patients in each group. Compared with the control group, the total effective rate was higher (92.5% vs. 62.5%, P=0.001), the occurrence time of granulation tissue (6.4±0.72 vs. 10.8 ±1.9, P=0.000) and wound healing time (31.3±8.2 vs. 47.4±11.5, P=0.000) were shorter, and the wound area reduction ration was greater (46.3±7.6 vs. 32.6±6.1, P=0.000) in the silver ions dressing group with significant differences. ConclusionThe effects of silver-containing dressings is superior to Vaseline dressing in the treatment of diabetic foot ulcers.
Objective To explore the feasibility and effectiveness of free vastus lateralis flap combined with skin grafting for repairing small- and medium-sized lacunar defects in the non-weight-bearing area of diabetic foot. Methods Between January 2022 and October 2023, 8 patients (8 feet) with small- and medium-sized lacunar defects in the non-weight-bearing area of diabetic foot were admitted. There were 6 males and 2 females, with an average age of 64.3 years (range, 58-76 years). The duration of the diabetic foot ulcer ranged from 2 to 7 weeks (mean, 4.3 weeks). The wound was located between the metatarsal bones in 4 cases, on the medial side of the foot in 2 cases, on the lateral side of the foot in 1 case, and on the dorsal and lateral sides of the foot in 1 case. The length of wound was 4.0-12.0 cm, the width was 3.0-5.0 cm, and the depth was 1.2-2.0 cm. The free vastus lateralis flaps were designed to repair the wounds, and skin grafting covered the vastus lateralis flaps. The length of the vastus lateralis flap was 5.0-14.0 cm, the width was 3.5-6.0 cm, and the thickness was 1.0-1.5 cm. The donor sites of the muscle flaps were directly sutured. Results The time for vastus lateralis flaps harvested ranged from 30 to 80 minutes (mean, 55.0 minutes), and the total operation time ranged from 125 to 170 minutes (mean, 147.5 minutes). All muscle flaps and skin grafts survived successfully, and the wounds and the incisions at the donor sites healed by first intention. All patients were followed up 6-24 months, with an average of 12.8 months. The appearances of 3 patients who did not follow the doctor’s instructions for pressure treatment of the muscle flaps were a little bloated, and the rest had a good appearance. The texture of the muscle flaps was soft. There were linear scars at the donor sites. There was no recurrence of ulcers during follow-up. All patients could walk independently without limitation of daily activities at last follow-up. Conclusion The application of free vastus lateralis flap combined with skin grafting to repair small- and medium-sized lacunar defects in the non-weight-bearing area of diabetic foot has the advantages of simple operation and time-saving as well as small damage to the donor site, with good repair effect, especially for the elderly patients who are not suitable for prolonged anesthesia.
ObjectiveTo investigate the effect of α-lipoic acid on the oxidative stress of wound tissues and diabetic wound healing in mice with diabetic feet. MethodsSixty male C57BL/6J mice weighting 200-300 g were randomly divided into model group (control group, n=15), α-lipoic acid-treated model group (n=15), miR-29b mimic group (n=15), and miR-29b mimic negative control group (NC group, n=15). All animals received intraperitoneal injection of streptozocin to establish the diabetic model. Then, a full thickness wound of 5 mm×2 mm in size was created at 4 weeks after modeling. All mice were administrated with high-sugar-fat-diet. At the same day after modeling, α-lipoic acid-treated model group was continuously given intravenous injection of 100 mg/(kg·d) α-lipoic acid for 14 days; miR-29b mimic group and NC group received the tail intravenous injection of lentiviral vector for miR-29b mimic and miR-29b mimic negative control (a total of 2×107 TU), respectively, with the treatment of α-lipoic acid. The wound healing was observed and wound area was measured at 7 and 14 days. The wound tissues were harvested to detect the levels of superoxide dismutase (SOD) and glutathione (GSH) using xanthine oxidase method and 5, 5-dithiobis-2-nitrobenzoic acid staining method at 14 days. At the same day, 7, and 14 days after modeling, the relative miR-29b expression in wound tissues from control and α-lipoic acid-treated model groups was detected by real-time fluorescence quantitative PCR. ResultsAll mice survived to the experiment end. The wound healing was faster in α-lipoic acid-treated group than control group. At 7 and 14 days, the relative wound area and miR-29b expression level were significantly lower, while the contents of SOD and GSH were significantly higher in α-lipoic acid-treated group than control group (P < 0.05). In addition, miR-29b mimic group had significantly increased relative wound area and significantly decreased the contents of SOD and GSH when compared with NC group at 7 and 14 days (P < 0.05). Conclusionα-lipoic acid could inhibit oxidative stress and promote diabetic wound healing by suppressing expression of miR-29b in mice.
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.
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.
Objective To assess the effectiveness of intensive versus routine education on diabetes mellitus for preventing diabetic foot ulcer. Methods We electronically searched CENTRAL (Issue 1, 2013), PubMed (1978-2013), EMbase (1978-2013), VIP (1989-2013) and WanFang Data (1980-2013), hand-searched correlated proceedings and retrieved the references of included studies, for the randomized controlled trials on intensive versus routine education on diabetes mellitus for preventing diabetic foot ulcer all over the world. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results Twelve trials involving 1 841 patients were finally included. The results of meta-analysis showed that: a) the incidence of diabetic foot ulcer in the intensive education group was lower than the routine group, with a significant difference (RR=0.51, 95%CI 0.30 to 0.84, P=0.008); b) two groups were alike in the amputation rate, with no significant difference (OR=0.54, 95%CI 0.17 to 1.67, P=0.28); and c) the score of knowledge on diabetes mellitus was higher in the intensive education group than in the routine education group, with a significant difference (MD=7.32, 95%CI 3.57 to 11.06, P=0.000 1). Conclusion Current evidence shows that: compared with routine education, intensive education could reduce the incidence of diabetic foot ulcer effectively. However, the above conclusion should be verified by conducting more high quality studies.