Clinical application of nose ring drain in severe diabetic foot infection_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 TIAN Lin ¹ , Aikebaier·Yasen ¹ , TAN Yuzhong ² , LI Faxiang ² , GAO Bo ² , CHENG Liangkun ² , HE Dong ² , QU Long ²

1. Microsurgery Center for Wound Repair, Chongqing Great Wall Hospital, Chongqing, 400041, P.R.China;
2. Department of Orthopedics, Aerospace 731 Hospital, Beijing, 100074, P.R.China;

Corresponding author：

TIAN Lin, Email: 50273414@qq.com

Keywords：

Diabetic foot; wound infection; nose ring drain

DOI：

10.7507/1002-1892.202003190

Video：

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Objective To evaluate the effectiveness of the nose ring drain (NRD) in treatment of severe diabetic foot infection.Methods The clinical data of 35 patients with severe diabetic foot infection who were treated with NRD between June 2017 and June 2019 were analyzed retrospectively. There were 24 males and 11 females with an average age of 54.5 years (range, 28-82 years). All of them were type 2 diabetic patients. The diabetes duration was 3-20 years, with an average of 9.4 years. The diabetic foot duration was 4 months to 2 years, with an average of 1.16 years. There were 16 cases of left foot and 19 cases of right foot. According to Wagner’s grading, there were 11 cases of grade 2, 20 cases of grade 3, and 4 cases of grade 4, all of which were moderate and severe infection of diabetic foot wound. Postoperative wounds were treated with “nibble-like” debridement until the patient’s epidermis regenerated and healed. During the treatment process, the indexes of bacterial culture type of wound secretions, duration of antibiotic therapy, wound healing method, healing time, amputation rate, and other indicators were analyzed and summarized.Results All 35 patients were followed up 3-6 months, with an average of 4.5 months. Postoperative bacterial culture of wounds showed that 5 cases of Staphylococcus aureus, 4 cases of Pseudomonas aeruginosa, 5 cases of Escherichia coli, 3 cases of Enterobacter cloacae, 3 cases of coagulase-negative Staphylococcus, and 15 cases of other types were detected. The duration of antibiotic therapy ranged from 3 to 15 days, with an average of 9.1 days. The wound was autolytically healed without skin grafting, and the healing time was 62-82 days, with an average of 72.3 days. During the follow-up, 3 cases (8.6%) had amputation due to the patient’s poor blood glucose control, which led to a large spread of infection. In addition, among the other patients with wound healing, there was no recurrence of wound infection or new ulcer on the original surface.Conclusion The NRD is a simple operation for treatment of severe diabetic foot infection, which can effectively control wound infections and promote wound healing and regeneration without skin grafting.

Citation： TIAN Lin, Aikebaier·Yasen, TAN Yuzhong, LI Faxiang, GAO Bo, CHENG Liangkun, HE Dong, QU Long. Clinical application of nose ring drain in severe diabetic foot infection. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(8): 990-993. doi: 10.7507/1002-1892.202003190 Copy

1.	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.
2.	孙权. 负压封闭引流技术治疗糖尿病足溃疡的临床效果. 临床合理用药杂志, 2019, 12(6): 134-135.
3.	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.
4.	谷涌泉. 中国糖尿病足诊治指南. 中国临床医生杂志, 2020, 48(1): 19-26.
5.	中华医学会糖尿病学分会, 中华医学会感染病学分会, 中华医学会组织修复与再生分会. 中国糖尿病足防治指南 (2019版)(Ⅰ). 中华糖尿病杂志, 2019, 11(2): 92-108.
6.	曲龙. 骨搬移治疗骨缺损与骨不连 Ilizarov 技术的临床应用. 2版. 北京: 人民卫生出版社, 2009: 8.
7.	马敬第, 黄冬梅, 徐明喜, 等. 牛鼻子对口引流和逐步清创在糖尿病足溃疡保肢中的应用. 临床医药文献电子杂志, 2019, 6(29): 13, 16.
8.	Takei T, Danjo S, Sakoguchi S, et al. Autoclavable physically-crosslinked chitosan cryogel as a wound dressing. J Biosci Bioeng, 2018, 125(4): 490-495.
9.	Hodgson H, Davidson D, Duncan A, et al. Clinical evaluation of a hydro-responsive wound dressing: the Glasgow experience. J Wound Care, 2017, 26(11): 642-650.
10.	João Guilherme B De Marchi, Denise S Jornada, Fernanda K Silva, et al. Triclosan resistance reversion by encapsulation in chitosan-coated-nanocapsule containing α-bisabolol as core: development of wound dressing. Int J Nanomedicine, 2017, 12: 7855-7868.
11.	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.
12.	王江宁, 高磊. 糖尿病足慢性创面治疗的新进展. 中国修复重建外科杂志, 2018, 32(7): 832-837.
13.	Blume PA, Donegan R, Schmidt BM. The role of plastic surgery for soft tissue coverage of the diabetic foot and ankle. Clin Podiatr Med Surg, 2014, 31(1): 127-150.
14.	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. Diabetic Foot & Ankle, 2015, 6(1): 27618.
15.	Li P, Ning XH, 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.

1. 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.
2. 孙权. 负压封闭引流技术治疗糖尿病足溃疡的临床效果. 临床合理用药杂志, 2019, 12(6): 134-135.
3. 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.
4. 谷涌泉. 中国糖尿病足诊治指南. 中国临床医生杂志, 2020, 48(1): 19-26.
5. 中华医学会糖尿病学分会, 中华医学会感染病学分会, 中华医学会组织修复与再生分会. 中国糖尿病足防治指南 (2019版)(Ⅰ). 中华糖尿病杂志, 2019, 11(2): 92-108.
6. 曲龙. 骨搬移治疗骨缺损与骨不连 Ilizarov 技术的临床应用. 2版. 北京: 人民卫生出版社, 2009: 8.
7. 马敬第, 黄冬梅, 徐明喜, 等. 牛鼻子对口引流和逐步清创在糖尿病足溃疡保肢中的应用. 临床医药文献电子杂志, 2019, 6(29): 13, 16.
8. Takei T, Danjo S, Sakoguchi S, et al. Autoclavable physically-crosslinked chitosan cryogel as a wound dressing. J Biosci Bioeng, 2018, 125(4): 490-495.
9. Hodgson H, Davidson D, Duncan A, et al. Clinical evaluation of a hydro-responsive wound dressing: the Glasgow experience. J Wound Care, 2017, 26(11): 642-650.
10. João Guilherme B De Marchi, Denise S Jornada, Fernanda K Silva, et al. Triclosan resistance reversion by encapsulation in chitosan-coated-nanocapsule containing α-bisabolol as core: development of wound dressing. Int J Nanomedicine, 2017, 12: 7855-7868.
11. 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.
12. 王江宁, 高磊. 糖尿病足慢性创面治疗的新进展. 中国修复重建外科杂志, 2018, 32(7): 832-837.
13. Blume PA, Donegan R, Schmidt BM. The role of plastic surgery for soft tissue coverage of the diabetic foot and ankle. Clin Podiatr Med Surg, 2014, 31(1): 127-150.
14. 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. Diabetic Foot & Ankle, 2015, 6(1): 27618.
15. Li P, Ning XH, 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.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of nose ring drain in severe diabetic foot infection

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