Treatment of diabetic foot with vaccum sealing drainage combined with transverse tibial bone transport_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DONG Shunan ^1,2 ,  HUANG Dong ² , ZHU Lilin ² , LIU Xiaoyan ³

1. Department of Traumatology and Orthopedics, Second People’s Hospital of Guangdong Province, Guangzhou Guangdong, 510317, P.R.China;
2. Graduate School of Guangdong Medical University, Zhanjiang Guangdong, 524000, P.R.China;
3. Department of Science and Education, the Third Affiliated Hospital of Guizhou Medical University, Duyun Guizhou, 558000, P.R.China;

Corresponding author：

HUANG Dong, Email: dong-177@163.com

Keywords：

Diabetic foot; vacuum sealing drainage; transverse tibial bone transport; Ilizarov technique; wound repair

DOI：

10.7507/1002-1892.201911150

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the effectiveness and experience of Wanger grade 3-5 diabetic foot treated with vacuum sealing drainage (VSD) combined with transverse tibial bone transport.Methods Between March 2015 and January 2018, 21 patients with refractory diabetic foot who failed conservative treatment were treated with VSD combined with transverse tibial bone transport. There were 15 males and 6 females, aged 55-88 years (mean, 65 years). The diabetes history was 8-15 years (mean, 12.2 years). The duration of diabetic foot ranged from 7 to 84 days (mean, 35.3 days). The size of diabetic foot ulcer before operation ranged from 2 cm×2 cm to 8 cm×5 cm. According to Wanger classification, 8 cases were rated as grade 3, 11 cases as grade 4, and 2 cases as grade 5. Among the 21 cases, angiography of lower extremity before operation was performed in 5 cases, CT angiography of lower extremity in 16 cases, all of which indicated that the arteries below the knee were narrowed to varying degrees and not completely blocked. Preoperative foot skin temperature was (29.28±0.77)℃, C-reactive protein was (38.03±31.23) mg/L, leukocyte count was (9.44±2.21)×10⁹/L, and the visual analogue scale (VAS) score was 6.8±1.5, and ability of daily living (Barthel index) was 54.3±10.3.Results After operation, 2 patients with Wanger grade 4 and smoking history failed treatment and had an major amputation (amputation above ankle joint) at 30 days and 45 days after operation, respectively. One patient with Wanger grade 5 and chronic heart failure died of cardiac arrest at 60 days after operation. The remaining 18 patients were followed up 6-24 months (mean, 9.2 months). The external fixator was removed at 40-62 days after operation, with an average of 46 days. All the wounds healed, with a healing time of 50-120 days (mean, 62.5 days). The pain of 18 patients’ feet was relieved obviously, and there was no recurrence of ulcer in situ or other parts. There was no complication such as tibial fracture and ischemic necrosis of lower leg skin after operation. After ulcer healing, the foot skin temperature was (30.86±0.80)℃, C-reactive protein was (22.90±18.42) mg/L, VAS score was 2.4±1.2, and Barthel index was 77.3±4.6, all showing significant differences when compared with preoperative ones (P<0.05); the leukocyte count was (8.91±1.72)×10⁹/L, showing no significant difference (t=1.090, P=0.291).Conclusion VSD combined with transverse tibial bone transport can effectively promote the healing of Wanger grade 3-5 diabetic foot wounds, but smokers, unstable blood glucose control, and chronic heart failure patients have the risk of failure.

Citation： DONG Shunan, HUANG Dong, ZHU Lilin, LIU Xiaoyan. Treatment of diabetic foot with vaccum sealing drainage combined with transverse tibial bone transport. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(7): 869-873. doi: 10.7507/1002-1892.201911150 Copy

1.	International Diabetes Federation. IDF Diabetes Atlas. 7th Eds. http://www.diabetesatlas.org, 2017-08-06.
2.	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.
3.	Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation. Basis for prevention. Diabetes Care, 1990, 13(5): 513-521.
4.	Li X, Xiao T, Wang Y, et al. Incidence, risk factors for amputation among patients with diabetic foot ulcer in a Chinese tertiary hospital. Diabetes Res Clin Pract, 2011, 93(1): 26-30.
5.	Apelqvist J. Epidemiology of diabetic foot disease and etiology of ulceration. Diabetic Foot Ankle, 2014: 3-9.
6.	Cianci PE. The treatment of diabetic foot ulcers: a historical perspective. Undersea Hyperb Med, 2018, 45(2): 225-229.
7.	Uçkay I, Gariani K, Pataky Z, et al. Diabetic foot infections: state-of-the-art. Diabetes Obes Metab, 2014, 16(4): 305-316.
8.	Cruciani M, Lipsky BA, Mengoli C, et al. Granulocyte-colony stimulating factors as adjunctive therapy for diabetic foot infections. Cochrane Database Syst Rev, 2009, (3): CD006810.
9.	Game F, Jeffcoate W, Tarnow L, et al. LeucoPatch system for the management of hard-to-heal diabetic foot ulcers in the UK, Denmark, and Sweden: an observer-masked, randomised controlled trial. Lancet Diabetes Endocrinol, 2018, 6(11): 870-878.
10.	Edmonds M, Lázaro-Martínez JL, Alfayate-García JM, et al. Sucrose octasulfate dressing versus control dressing in patients with neuroischaemic diabetic foot ulcers (Explorer): an international, multicentre, double-blind, randomised, controlled trial. Lancet Diabetes Endocrinol, 2018, 6(3): 186-196.
11.	Edmonds ME, Bodansky HJ, Boulton AJM, et al. Multicenter, randomized controlled, observer-blinded study of a nitric oxide generating treatment in foot ulcers of patients with diabetes-ProNOx1 study. Wound Repair Regen, 2018, 26(2): 228-237.
12.	秦泗河. Ilizarov 技术概述. 中华骨科杂志, 2006, 26(9): 642-645.
13.	曲龙, 王爱林, 汤福刚. 胫骨横向搬移血管再生术治疗血栓闭塞性脉管炎. 中华医学杂志, 2001, 81(10): 622-624.
14.	李宏烨, 尤加省, 刘超, 等. 胫骨横向骨搬运术治疗糖尿病足溃疡的疗效. 中国修复重建外科杂志, 2019, 33(1): 23-27.
15.	Nemcová J, Hlinková E, Farský I, et al. Quality of life in patients with diabetic foot ulcer in Visegrad countries. J Clin Nurs, 2017, 26(9-10): 1245-1256.
16.	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.
17.	Mudiganty S, Daolagupu AK, Sipani AK, et al. Treatment of infected non-unions with segmental defects with a rail fixation system. Strategies Trauma Limb Reconstr, 2017, 12(1): 45-51.
18.	Zuo Q, Gao F, Song H, et al. Application of Ilizarov transverse tibial bone transport and microcirculation reconstruction in the treatment of chronic ischemic diseases in lower limbs. Exp Ther Med, 2018, 16(2): 1355-1359.
19.	胡承浩, 李东宇, 庞宗超, 等. 封闭式负压引流技术治疗糖尿病足对创面组织中 TGF-β₁ 及其受体表达的影响研究. 中国修复重建外科杂志, 2018, 32(8): 1061-1065.
20.	Herscovici D Jr, Sanders RW, Scaduto JM, et al. Vacuum-assisted wound closure (VAC therapy) for the management of patients with high-energy soft tissue injuries. J Orthop Trauma, 2003, 17(10): 683-688.
21.	Grigoropoulou P, Eleftheriadou I, Jude EB, et al. Diabetic foot infections: an update in diagnosis and management. Curr Diabetes Rep, 2017, 17(1): 3.
22.	Dinh T, Snyder G, Veves A. Current techniques to detect foot infection in the diabetic patient. Int J Low Extr Wound, 2010, 9(1): 24-30.
23.	Oba S, Suzuki E, Yamamoto M, et al. Active and passive exposure to tobacco smoke in relation to insulin sensitivity and pancreatic β-cell function in Japanese subjects. Diabetes Matab, 2015, 41(2): 160-167.
24.	Everett E, Mathioudakis N. Update on management of diabetic foot ulcers. Ann N Y Acad Sci, 2018, 1411(1): 153-165.
25.	Karr JC. The diagnosis of osteomyelitis in diabetes using erythrocyte sedimentation rate. J Am Podiatr Med Assoc, 2002, 92(5): 314-315.
26.	Dworkin MS, Westercamp MD, Park L, et al. The epidemiology of necrotizing fasciitis including factors associated with death and amputation. Epidemiol Infect, 2009, 137(11): 1609-1614.

1. International Diabetes Federation. IDF Diabetes Atlas. 7th Eds. http://www.diabetesatlas.org, 2017-08-06.
2. 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.
3. Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation. Basis for prevention. Diabetes Care, 1990, 13(5): 513-521.
4. Li X, Xiao T, Wang Y, et al. Incidence, risk factors for amputation among patients with diabetic foot ulcer in a Chinese tertiary hospital. Diabetes Res Clin Pract, 2011, 93(1): 26-30.
5. Apelqvist J. Epidemiology of diabetic foot disease and etiology of ulceration. Diabetic Foot Ankle, 2014: 3-9.
6. Cianci PE. The treatment of diabetic foot ulcers: a historical perspective. Undersea Hyperb Med, 2018, 45(2): 225-229.
7. Uçkay I, Gariani K, Pataky Z, et al. Diabetic foot infections: state-of-the-art. Diabetes Obes Metab, 2014, 16(4): 305-316.
8. Cruciani M, Lipsky BA, Mengoli C, et al. Granulocyte-colony stimulating factors as adjunctive therapy for diabetic foot infections. Cochrane Database Syst Rev, 2009, (3): CD006810.
9. Game F, Jeffcoate W, Tarnow L, et al. LeucoPatch system for the management of hard-to-heal diabetic foot ulcers in the UK, Denmark, and Sweden: an observer-masked, randomised controlled trial. Lancet Diabetes Endocrinol, 2018, 6(11): 870-878.
10. Edmonds M, Lázaro-Martínez JL, Alfayate-García JM, et al. Sucrose octasulfate dressing versus control dressing in patients with neuroischaemic diabetic foot ulcers (Explorer): an international, multicentre, double-blind, randomised, controlled trial. Lancet Diabetes Endocrinol, 2018, 6(3): 186-196.
11. Edmonds ME, Bodansky HJ, Boulton AJM, et al. Multicenter, randomized controlled, observer-blinded study of a nitric oxide generating treatment in foot ulcers of patients with diabetes-ProNOx1 study. Wound Repair Regen, 2018, 26(2): 228-237.
12. 秦泗河. Ilizarov 技术概述. 中华骨科杂志, 2006, 26(9): 642-645.
13. 曲龙, 王爱林, 汤福刚. 胫骨横向搬移血管再生术治疗血栓闭塞性脉管炎. 中华医学杂志, 2001, 81(10): 622-624.
14. 李宏烨, 尤加省, 刘超, 等. 胫骨横向骨搬运术治疗糖尿病足溃疡的疗效. 中国修复重建外科杂志, 2019, 33(1): 23-27.
15. Nemcová J, Hlinková E, Farský I, et al. Quality of life in patients with diabetic foot ulcer in Visegrad countries. J Clin Nurs, 2017, 26(9-10): 1245-1256.
16. 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.
17. Mudiganty S, Daolagupu AK, Sipani AK, et al. Treatment of infected non-unions with segmental defects with a rail fixation system. Strategies Trauma Limb Reconstr, 2017, 12(1): 45-51.
18. Zuo Q, Gao F, Song H, et al. Application of Ilizarov transverse tibial bone transport and microcirculation reconstruction in the treatment of chronic ischemic diseases in lower limbs. Exp Ther Med, 2018, 16(2): 1355-1359.
19. 胡承浩, 李东宇, 庞宗超, 等. 封闭式负压引流技术治疗糖尿病足对创面组织中 TGF-β₁ 及其受体表达的影响研究. 中国修复重建外科杂志, 2018, 32(8): 1061-1065.
20. Herscovici D Jr, Sanders RW, Scaduto JM, et al. Vacuum-assisted wound closure (VAC therapy) for the management of patients with high-energy soft tissue injuries. J Orthop Trauma, 2003, 17(10): 683-688.
21. Grigoropoulou P, Eleftheriadou I, Jude EB, et al. Diabetic foot infections: an update in diagnosis and management. Curr Diabetes Rep, 2017, 17(1): 3.
22. Dinh T, Snyder G, Veves A. Current techniques to detect foot infection in the diabetic patient. Int J Low Extr Wound, 2010, 9(1): 24-30.
23. Oba S, Suzuki E, Yamamoto M, et al. Active and passive exposure to tobacco smoke in relation to insulin sensitivity and pancreatic β-cell function in Japanese subjects. Diabetes Matab, 2015, 41(2): 160-167.
24. Everett E, Mathioudakis N. Update on management of diabetic foot ulcers. Ann N Y Acad Sci, 2018, 1411(1): 153-165.
25. Karr JC. The diagnosis of osteomyelitis in diabetes using erythrocyte sedimentation rate. J Am Podiatr Med Assoc, 2002, 92(5): 314-315.
26. Dworkin MS, Westercamp MD, Park L, et al. The epidemiology of necrotizing fasciitis including factors associated with death and amputation. Epidemiol Infect, 2009, 137(11): 1609-1614.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of diabetic foot with vaccum sealing drainage combined with transverse tibial bone transport

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content