Treatment of severe diabetic foot ulcer using tibia transverse transport combined with nose ring drain_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YU Jie ¹ , HUA Qikai ^1,2 , KUANG Xiaocong ³ , LIU Jie ⁴ , LIU Guangwei ^1,5 , LI Shanlang ^4,5 , NIE Xinyu ^4,5 , SU Hongjie ^4,5 , DING Yi ¹ , ZHONG Zhaowei ¹ , YANG Jiangtao ¹ , HE Liexun ¹ ,  CHEN Yan ¹

1. Department of Bone and Joint Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021, P.R.China;
2. Guangxi Diabetic Foot Salvage Engineering Research Center, Nanning Guangxi, 530021, P.R.China;
3. School of Basic Medicine, Guangxi Medical University, Nanning Guangxi, 530021, P.R.China;
4. Guangxi Collaborative Innovation Center of Biomedicine, Nanning Guangxi, 530021, P.R.China;
5. Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning Guangxi, 530021, P.R.China;

Corresponding author：

CHEN Yan, Email: cy003@connect.hku.hk

Keywords：

Diabetic foot; ulcer; tibia transverse transport; nose ring drain

DOI：

10.7507/1002-1892.202103039

Video：

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Objective To investigate the effectiveness of tibial transverse transport (TTT) combined with nose ring drain (NRD) in the treatment of severe diabetic foot ulcer.Methods The clinical data of 60 patients with severe diabetic foot (Wagner grade 3 or 4) ulcer who were admitted between April 2017 and August 2020 and met the selection criteria were retrospectively analyzed. Among them, 30 cases were treated with TTT combined with NRD (TTT+NRD group), and 30 cases were treated with TTT (TTT group). There was no significant difference in gender, age, diabetes duration, preoperative glycated hemoglobin, comorbidities, wound area, and duration, side, and grade of diabetic foot (P>0.05). The wound healing time, wound healing rate, amputation rate, recurrence rate, duration of antibiotic therapy, hospital stay, number of hospitalizations, and number of operations were recoreded and compared between the two groups.Results No obvious surgical complications occurred in the two groups. Patients in both groups were followed up 3-13 months, with an average of 5.7 months. The duration of antibiotic therapy and hospital stay in the TTT+NRD group were significantly shorter than those in the TTT group (P<0.05). There was no significant difference in wound healing time, wound healing rate, number of hospitalizations, and number of operations between the two groups (P>0.05). During follow-up, there was no recurrence of ulcer in the TTT+NRD group while 2 recurrent cases (6.7%) in the TTT group. The difference in recurrence rate was not significant (P=0.492). One case (3.3%) in the TTT+NRD group underwent amputation due to acute lower extremity vascular embolism, and 1 case (3.3%) in the TTT group underwent amputation due to secondary necrosis. The difference in amputation rate was not significant between the two groups (P=1.000).Conclusion TTT combined with NRD is an effective method for the treatment of severe diabetic foot ulcers with deep infections or relatively closed cavities or sinuses. It can shorten the time of antibiotic use and the length of hospitalization; and the NRD has a good drainage effect without obvious comorbidities, procedure and the postoperative care are simple and easy to obtain materials.

Citation： YU Jie, HUA Qikai, KUANG Xiaocong, LIU Jie, LIU Guangwei, LI Shanlang, NIE Xinyu, SU Hongjie, DING Yi, ZHONG Zhaowei, YANG Jiangtao, HE Liexun, CHEN Yan. Treatment of severe diabetic foot ulcer using tibia transverse transport combined with nose ring drain. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(8): 984-988. doi: 10.7507/1002-1892.202103039 Copy

1.	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.
2.	Cho NH, Shaw JE, Karuranga S, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract, 2018, 138: 271-281.
3.	中国医疗保健国际交流促进会糖尿病足病分会. 中国糖尿病足诊治指南. 中华医学杂志, 2017, 97(4): 251-258.
4.	张定伟, 秦泗河, 臧建成. Ilizarov微循环重建技术治疗Wagner4级糖尿病足临床疗效分析. 中国矫形外科杂志, 2017, 25(4): 354-356.
5.	欧栓机, 齐勇, 孙鸿涛, 等. 经皮微创胫骨截骨横向骨搬移术治疗糖尿病足. 中国矫形外科杂志, 2018, 26(15): 1385-1389.
6.	王林华, 周富强, 卢敏, 等. 应用Ilizarov横向骨搬移技术微创截骨治疗糖尿病足13例. 中国中医骨伤科杂志, 2018, 26(11): 42-45.
7.	花奇凯, 秦泗河, 赵良军, 等. Ilizarov技术胫骨横向骨搬移术治疗糖尿病足. 中国矫形外科杂志, 2017, 25(4): 303-307.
8.	Chen Y, Kuang X, Zhou J, et al. Proximal tibial cortex transverse distraction facilitating healing and limb salvage in severe and recalcitrant diabetic foot ulcers. Clin Orthop Relat Res, 2020, 478(4): 836-851.
9.	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. Diabet Foot Ankle, 2015, 6: 27618. doi: 10.3402/dfa.v6.27618.
10.	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.
11.	曲龙. 骨搬移治疗骨缺损与骨不连-Ilizarov技术的临床应用. 北京: 人民卫生出版社, 2009: 44-48.
12.	张平荣, 任静, 孙嵘, 等. 牛鼻子引流术在感染性伤口治疗中的应用. 中国骨与关节损伤杂志, 2018, 33(7): 780-781.
13.	Wagner FW. The dysvascular foot: a system for diagnosis and treatment. Foot Ankle, 1981, 2(2): 64-122.
14.	何立环, 陈炎, 邝晓聪, 等. 重度糖尿病足胫骨横向骨搬移术治疗后创面愈合规律分析. 中医正骨, 2019, 31(10): 790-793.
15.	Nie X, Kuang X, Liu G, et al. Tibial cortex transverse transport facilitating healing in patients with recalcitrant non-diabetic leg ulcers. J Orthop Translat, 2020, 27: 1-7.
16.	高伟, 林震迅, 镇普祥, 等. 胫骨横向骨搬移后巨噬细胞促进重度糖尿病足创面的愈合. 中国组织工程研究, 2018, 22(36): 5811-5815.
17.	Li P, Ning X, 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.
18.	马敬弟, 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.
19.	田林, 谭玉忠, 李发祥, 等. 牛鼻子引流术在严重糖尿病足感染创面中的临床应用. 中国修复重建外科杂志, 2020, 34(8): 990-993.

1. 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.
2. Cho NH, Shaw JE, Karuranga S, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract, 2018, 138: 271-281.
3. 中国医疗保健国际交流促进会糖尿病足病分会. 中国糖尿病足诊治指南. 中华医学杂志, 2017, 97(4): 251-258.
4. 张定伟, 秦泗河, 臧建成. Ilizarov微循环重建技术治疗Wagner4级糖尿病足临床疗效分析. 中国矫形外科杂志, 2017, 25(4): 354-356.
5. 欧栓机, 齐勇, 孙鸿涛, 等. 经皮微创胫骨截骨横向骨搬移术治疗糖尿病足. 中国矫形外科杂志, 2018, 26(15): 1385-1389.
6. 王林华, 周富强, 卢敏, 等. 应用Ilizarov横向骨搬移技术微创截骨治疗糖尿病足13例. 中国中医骨伤科杂志, 2018, 26(11): 42-45.
7. 花奇凯, 秦泗河, 赵良军, 等. Ilizarov技术胫骨横向骨搬移术治疗糖尿病足. 中国矫形外科杂志, 2017, 25(4): 303-307.
8. Chen Y, Kuang X, Zhou J, et al. Proximal tibial cortex transverse distraction facilitating healing and limb salvage in severe and recalcitrant diabetic foot ulcers. Clin Orthop Relat Res, 2020, 478(4): 836-851.
9. 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. Diabet Foot Ankle, 2015, 6: 27618. doi: 10.3402/dfa.v6.27618.
10. 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.
11. 曲龙. 骨搬移治疗骨缺损与骨不连-Ilizarov技术的临床应用. 北京: 人民卫生出版社, 2009: 44-48.
12. 张平荣, 任静, 孙嵘, 等. 牛鼻子引流术在感染性伤口治疗中的应用. 中国骨与关节损伤杂志, 2018, 33(7): 780-781.
13. Wagner FW. The dysvascular foot: a system for diagnosis and treatment. Foot Ankle, 1981, 2(2): 64-122.
14. 何立环, 陈炎, 邝晓聪, 等. 重度糖尿病足胫骨横向骨搬移术治疗后创面愈合规律分析. 中医正骨, 2019, 31(10): 790-793.
15. Nie X, Kuang X, Liu G, et al. Tibial cortex transverse transport facilitating healing in patients with recalcitrant non-diabetic leg ulcers. J Orthop Translat, 2020, 27: 1-7.
16. 高伟, 林震迅, 镇普祥, 等. 胫骨横向骨搬移后巨噬细胞促进重度糖尿病足创面的愈合. 中国组织工程研究, 2018, 22(36): 5811-5815.
17. Li P, Ning X, 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.
18. 马敬弟, 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.
19. 田林, 谭玉忠, 李发祥, 等. 牛鼻子引流术在严重糖尿病足感染创面中的临床应用. 中国修复重建外科杂志, 2020, 34(8): 990-993.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of severe diabetic foot ulcer using tibia transverse transport combined with nose ring drain

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