- Department of Orthopaedics, Beijing Shijitan Hospital, CMU, Beijing, 100038, P.R.China;
WANG Jiangning,
Email: dlwangjn@vip.sina.com
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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| 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. |
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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. 马静, 顾珮瑜, 陈敏, 等. 血必净对老年重度糖尿病足围手术期甲状腺激素水平影响作用的临床观察. 中国医院药学杂志, 2013, 33(17): 1412-1414.
- 15. 姜鹏, 许樟荣. 糖尿病足溃疡合并感染的抗生素治疗进展. 中华糖尿病杂志, 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, 许樟荣. 糖尿病神经病变的诊治进展. 中国医刊, 2017, 52(2): 8-11.
- 18. 姜玉峰, 许樟荣, 付小兵. 糖尿病足创面修复过程中清创问题. 中国实用内科杂志, 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. Ceřovský 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, 尹叶锋, 王寿宇. 纯化蛆虫分泌物抗菌肽对糖尿病大鼠溃疡创面的抗菌作用. 中国组织工程研究, 2012, 16(24): 4437-4440.
- 24. 王寿宇, 吕德成, 王媛媛, 等. 蛆虫分泌物对糖尿病大鼠溃疡组织 bFGF 和结缔组织生长因子表达的影响及抗菌作用研究. 中国修复重建外科杂志, 2008, 22(4): 472-475.
- 25. Uzun G, Mutluoğlu M, Karagöz 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, 刘燕玲, 等. 皮肤牵张闭合器在难愈性褥疮创面修复中的应用. 中华显微外科杂志, 2018, 41(1): 80-83.
- 33. 高磊, 王硕, 王雷, 等. 皮肤牵张闭合器在糖尿病足创面修复中的应用. 中国修复重建外科杂志, 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. 中华医学会糖尿病学分会. 2 型糖尿病患者合并下肢动脉病变的筛查及管理规范. 中华糖尿病杂志, 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. 国际血管联盟中国分会糖尿病足专业委员会. 糖尿病足诊治指南. 介入放射学杂志, 2013, 22(9): 705-708.
- 46. 杨磊, 高磊, 王雷, 等. 体外循环系统下加压灌注改善模型猪下肢血运. 中国组织工程研究, 2018, 22(4): 553-557.
- 47. 张绍春, 秦新愿, 左有为, 等. 脉络宁对体外模拟体内生理环境寄养断肢系统缺血/再灌注损伤模型的作用. 中国组织工程研究, 2014, (36): 5825-5829.
- 48. 尹叶锋, 王江宁, 高磊, 等. 不同温度对体外模拟体内生理环境寄养断肢系统的影响研究. 中国修复重建外科杂志, 2013, 27(1): 72-76.
- 49. 王江宁, 尹叶锋, 高磊, 等. 不同氧体积分数气体对体外模拟体内生理环境寄养断肢系统血氧分压的影响. 中国组织工程研究, 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.
- 52. Shchudlo N, Varsegova T, Stupina T, et al. Benefits of Ilizarov automated bone distraction for nerves and articular cartilage in experimental leg lengthening. World J Orthop, 2017, 8(9): 688-696.
- 53. 王斌, 杨漪舸. 股-股动脉旁路移植联合胫骨横向骨搬移术治疗动脉硬化闭塞症一例. 中国修复重建外科杂志, 2015, 29(9): 1188.
- 54. 张彦龙, 王泳, 邸军, 等. 单平面与双平面截骨骨搬移治疗胫骨大段感染性骨缺损的疗效比较. 中华创伤杂志, 2017, 33(6): 532-538.
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