Diabetic foot ulcer: assessment and management

Diabetic foot ulcer is a rising health problem with rising prevalence of diabetes. It is the most important cause of non-traumatic foot amputations. Diabetic foot ulcers are primarily due to neuropathy and/or ischaemia, and are frequently complicated by infection. Up to 85% of all diabetic foot related problems are preventable through a combination of good foot care and appropriate education for patients and healthcare providers. The holistic care of diabetic foot ulcer patients requires a multidisciplinary team approach. Apart from blood sugar control, treatment of ulcer involves debridement, offloading, appropriate dressings, vascular maintenance and infection control. Use of adjunctive treatments such as various growth factors, skin replacement dressings and vacuum assisted closure will accelerate healing in selected cases.     

紫朱软膏对金黄色葡萄球菌感染糖尿病足溃疡炎症反应及NF-κB/JNK/PI3K信号表达的影响

[目的]糖尿病足溃疡是糖尿病的严重的下肢并发症,感染对溃疡的愈合具有明显的延迟作用.金黄色葡萄球菌是糖尿病足溃疡常见的致病菌.感染导致的持续的炎症是造成糖尿病足溃疡迁延难愈的重要因素.本研究旨在从感染性炎症反应的角度探讨中药紫朱软膏在金黄色葡萄球菌感染糖尿病足溃疡模型愈合中的作用机制.[方法]采用高脂饲料配合链脲佐菌素...     

胫骨横向骨搬移技术联合外用象皮生肌膏对糖尿病足兔溃疡愈合影响的实验观察

目的采用胫骨横向骨搬移技术联合外用象皮生肌膏治疗糖尿病足兔溃疡,观察其溃疡愈合速度。方法将32只新西兰大白兔随机分成4组,每组8只,分别是模型组(A组)、象皮生肌膏组(B组)、横向骨搬移组(C组)、横向骨搬移+象皮生肌膏组(D组),通过高脂高糖饲料喂养后用四氧嘧啶溶液耳缘静脉注射诱导糖尿病模型,再用磁片压迫法建立糖尿病足溃疡模型,A组络合碘换药,B组象皮生肌膏换药,C组骨搬移法治疗,D组骨搬移法联合象皮生肌膏换药治疗,于第1天和第14天分别测量溃疡面积大小。结果通过四氧嘧啶溶液注射后实验兔出现精神倦怠、体质量减轻,血糖明显升高,证明糖尿病造模成功;干预14 d后,与A组比较,B、C组实验兔溃疡面积明显减小(P<0.01);与B组比较,C组实验兔溃疡面积有所减小(P<0.05);与C组比较,D组实验兔溃疡面积显著减小(P<0.01)。结论胫骨横向骨搬移技术联合外用象皮生肌膏能明显促进兔糖尿病足溃疡的愈合,值得临床推广。     

Casting methods and plantar pressure: effects of custom-made foot orthoses on dynamic plantar pressure distribution

Foot orthoses are widely used to treat various foot problems. A literature search revealed no publications on differences in plantar pressure distribution resulting from casting methods for foot orthoses. Four casting methods were used for construction of orthoses. Two foam box techniques were used: accommodative full weightbearing method (A) and functional semiweightbearing method (B). Also, two suspension plaster casting techniques were used: accommodative casting (C) and functional subtalar joint neutral position (Root) method (D). Their effects on contact area, plantar pressure, and walking convenience were evaluated. All orthoses increased the total contact area (mean, 17.4%) compared with shoes without orthoses. Differences in contact areas between orthoses for total plantar surface were statistically significant. Peak pressures for the total plantar surface were lower with orthoses than without orthoses (mean, 22.8%). Among orthoses, only the difference between orthoses A and B was statistically significant. Differences between orthoses for the forefoot were small and not statistically significant. The gait lines of the shoe without an insole and of the accommodative orthoses are more medially located than those of functional orthoses. Walking convenience in the shoe was better rated than that with orthoses. There were no differences in perception of walking convenience between orthoses A, B, and C. Orthosis D had the lowest convenience rating. The four casting methods resulted in differences between orthoses with respect to contact areas and walking convenience but only slight differences in peak pressures.     

两种换药方法在糖尿病足溃疡中的应用及护理

目的探讨两种不同的换药方法在糖尿病足溃疡中的应用及效果。方法选取2009年1月～2012年1月于本院创伤中心进行换药的糖尿病足溃疡患者60例,根据换药方法的不同随机分为观察组(胰岛素混合液持续湿敷)和对照组(常规换药方法)各30例,比较两组的疗效及溃疡愈合时间。结果观察组的有效率达90.0%,明显高于对照组;且观察组溃疡愈合时间明显短于对照组,差异存在统计学意义。结论两种不同的换药方法在糖尿病足溃疡中的应用均取得了较好的疗效,且在常规换药方法的基础上予以胰岛素混合液持续湿敷,可以提高治疗效果,缩短溃疡愈合时间,值得广泛推广和应用。     

银杏达莫静滴治疗糖尿病足溃疡

目的评价银杏迭莫注射液静脉滴注治疗糖尿病足溃疡的疗效。方法将71例Wagner分级1～2级的糖尿病足溃疡患者随机分为治疗组和对照组,治疗组在对照组用药的基础上给予银杏达莫注射液20ml／d静脉滴注,疗程4周;观察溃疡愈合情况及治疗前后血液流变学指标变化。结果治疗组总有效率83．3％,对照组总有效率57．1％,两组比较差异有显著性（P〈0．01）。治疗组血液流变学指标变化显著,且与对照组治疗后比较差异有显著性（P〈0．01）。结论银杏达莫注射液静脉滴注治疗糖尿病足溃疡疗效肯定。     

Comprehensive treatment of complicated plantar ulcers in leprosy

heNationalLeprosyRehabilitationProjectStage 2wasstartedinMay 1 995 Theprojectcovered 1 2 provincesandareasinChina:Shanghai,Jiangsu ,Zhejiang ,Anhui,Fujian ,Jiangxi,Shandong ,Hubei,Guangxi,Yunnan ,ShanxiandYangzhou ,whichwereevaluatedbyexpertsfromnon governmentorganizationsinApril 1 998 Inthisreport,wepresenttheresultsofcomprehensivetreatmentofcomplicatedfootulcers METHODSSubjectsAccordingtoanagreementbetweentheChineseMinistryofHealth (MOH)andtheLeprosyMissionInternational(LMI)…     

磺胺嘧啶银联合芦荟烧伤膏对糖尿病大鼠末梢循环障碍及足溃疡的保护作用

目的 研究磺胺嘧啶银联合芦荟烧伤膏对糖尿病大鼠足溃疡的保护作用并探讨其机制.方法 选取清洁级性成熟Wistar大鼠90只制成糖尿病大鼠模型,将成功造模的80只大鼠按照随机数表法分为末梢循环障碍模型组与足溃疡模型组,每组均40只.成功造模且符合研究要求的末梢循环障碍模型组(n=35)按照随机数表法分为对照组(n=18)与观察组(n=17),足溃疡模型组(n=36)按照随机数表法分为对照组(n=18)与观察组(n=18),所有大鼠均给予磺胺嘧啶涂抹患处,观察组在此基础上给予芦荟烧伤膏,连续给药35 d,治疗期间(1周、2周、3周)记录末梢循环障碍大鼠足底皮温、疼痛阈值,记录足溃疡大鼠溃疡面愈合情况及其外周血清血管内皮生长因子(VEGF).结果 末梢循环障碍模型组大鼠治疗过程中各个时间点观察组的足底温度高于对照组,而疼痛阈值低于对照组,且差异有统计学意义(P<0.05).足溃疡模型组大鼠治疗过程中各个时间点比较观察组溃疡愈合率、外周血清血管内皮生长因子(VEGF)均高于对照组,且差异有统计学意义(P<0.05).结论 磺胺嘧啶银联合芦荟烧伤膏能很好地改善糖尿病大鼠的末梢循环引起的温度及痛觉迟钝,与此同时能通过提高VEGF的表达促进足溃疡大鼠溃疡面愈合.     

负压封闭引流治疗糖尿病足的护理体会

目的探讨负压封闭引流（VSD）治疗糖尿病足的效果及其护理要点。方法分析37例应用VSD技术治疗糖尿病足患者的临床资料及护理措施。结果 37例糖尿病足患者中行1次VSD术者22例、行2次VSD术者14例、行3次VSD术者1例。经25～86d的治疗,11例足部溃疡完全愈合,26例创面缩小后经皮瓣移植术后创面愈合。结论 VSD术能有效促进糖尿病足创面肉芽组织形成,加速创面愈合,有效的护理措施是VSD成功的保证。     

Human amnion in the treatment of chronic ulceration of the legs

A prospective study to evaluate the efficacy of human amniotic membrane dressings in the treatment of chronic leg ulcers was conducted on 15 patients. Patients with two ulcers were selected. One ulcer was treated with human amnion and the other, treated with standard dressings, served as a control. The rate of healing of the two ulcers was observed and compared. Chronic ulcers of post-phlebitic, post-irradiation and post-burn origin responded to treatment with human amnion and healed more rapidly than the control ulcer. Ulcers associated with rheumatoid arthritis and vasculitis showed no improvement. It was observed that all ulcers treated with human amnion quickly became pain-free.     

初发糖尿病足溃疡患者足溃疡复发影响因素分析

目的 探讨初发糖尿病足溃疡(diabetic foot ulcer, DFU)患者溃疡复发率和影响复发的高危因素。方法 收集2011年1月—2015年12月住院的初发DFU患者227例的临床资料,对患者随访至2017年6月以获得DFU复发情况及分析影响复发高危预测因素。结果 189例（83.3%）完成随访,平均随访（3.736±1.391）年,中位随访时间3.570年。189例中85例（45.0%）溃疡复发,平均溃疡复发时间（2.738±1.545）年,中位溃疡复发时间2.370年。1年、3年、5年溃疡复发分别为29例、67例、82例。1年、3年、5年溃疡复发的发病密度分别为15.5%、39.4%和57.2%。溃疡复发组对比无复发组,年龄（≥60岁）、足底溃疡、周围血管病变、糖尿病周围神经病变所占比例升高,差异有统计学意义（P<0.05）。两组的男性、糖尿病病程（≥10年）、糖尿病足溃疡病程（≥1月）、吸烟、HbA1c(≥7.5%)、Wagner分级（≥3级）、截肢、糖尿病肾病、糖尿病视网膜病变、体重指数(≥24 kg/m²)、高血压病、血脂异常所占比例差异无统计学意义（P>0.05）。年龄、溃疡部位、周围血管病变、糖尿病周围神经病变是溃疡复发预测因素。溃疡部位（HR=1.886,95.0% CI 1.204~2.955）、周围血管病变（HR=1.801,95.0% CI 1.083~2.995）、糖尿病周围神经病变（HR=2.903,95.0% CI 1.565~5.384）是溃疡复发的独立高危预测因素。结论 糖尿病足溃疡远期复发率高,应对影响复发高危因素进行早期干预。     

蜂蜜敷料局部治疗糖尿病足部溃疡的效果评价

目的评价蜂蜜敷料局部治疗糖尿病足部溃疡的效果。方法抽取外科门诊就诊的糖尿病足溃疡患者105例,随机分为A、B、C三组,每组35例,分别使用自制的蜂蜜敷料、功能敷料和常规敷料治疗,观察三组伤口不同时间点的细菌清除率、面积愈合率及细菌清除时间、清创时间和治疗时间。结果蜂蜜敷料组(A组)的细菌清除率、面积愈合率明显优于B、C组(P<0.05),且细菌清除平均时间、清创时间和治疗时间短于功能敷料和常规敷料B、C组(P<0.05)。结论蜂蜜敷料治疗糖尿病足部溃疡有助于清除伤口感染和坏死组织,促进肉芽生长,有湿性愈合的作用。     

磁疗对糖尿病足溃疡大鼠模型创面愈合的影响

目的探讨磁疗对糖尿病大鼠慢性溃疡创面愈合的影响。方法首先40只Wistar大鼠糖尿病皮肤溃疡造模成功后24 h,随机法平均分为对照组和磁场治疗组,对照组使用无菌纱布覆盖创面;磁场治疗组将直径15 mm的钕铁硼稳恒磁片粘附在纱布表面,使用高斯计测得中心磁场强度(180±5)mT,静磁场暴露后第3天、第7天,对照组及磁场治疗组分别取材10只大鼠创面组织,通过创面红肿范围、肉芽组织生长、创面愈合率、感染率等形态学研究,初步判断其治疗效果。结果180 mT静磁场对于糖尿病足溃疡愈合具有显著疗效,与未暴露在磁场的创面相比,创缘红肿消退早,肉芽组织增多,创面愈合率增长,愈合时间明显缩短。结论磁场疗法是能够促进糖尿病足溃疡愈合的无创性物理治疗,它具有临床治疗糖尿病创伤愈合的良好前景。     

外用碱性成纤维细胞生长因子联合超短波治疗糖尿病足溃疡临床观察

目的 观察外用碱性成纤维细胞生长因子联合超短波治疗糖尿病足溃疡的临床疗效.方法 选择我院内分泌科于2015年1月至2016年4月期间收治的72例2型糖尿病合并糖尿病足溃疡患者为研究对象,根据随机数表法分为观察组和对照组,每组36例,对照组患者予控制血糖、抗感染等常规治疗,观察组患者在此基础上加用重组牛碱性成纤维细胞生长因子及超短波治疗,7d为一个疗程,治疗3个疗程.一个疗程后进行临床症状评分,3个疗程后比较两组患者的临床疗效.结果 治疗7d后,观察组患者的肉芽生长、渗出及水肿的症状评分分别为(0.96±0.39)分、(1.25±0.57)分及(1.42±0.66)分,均明显低于对照组的(1.38±0.58)分、(1.64±0.69)分及(1.97±0.85)分,差异均有统计学意义(P<0.05);治疗后,观察组患者的治疗总有效率为88.89%,明显高于对照组的69.44%,差异有统计学意义(P<0.05).结论 外用碱性成纤维细胞生长因子联合超短波治疗糖尿病足溃疡可以促进肉芽组织的生长、减少渗出及水肿,促进溃疡创面的愈合.     

糖尿病患者的足底压力分析

目的：探讨我国糖尿病（DM）患者足底压力参数与分布情况及其与糖尿病周围神经病变（DPN）的关系。方法使用Footscan SCSI 0.5米平板系统对68名糖尿病无周围神经病变患者（A组）和70名糖尿病合并周围神经病变患者（B组）进行静态和动态足底压力检测。结果1.前足及后足接触面积,B组〉A组（P〈0.05）;中足接触面积,B组〈A组（P〈0.01）。2.B组左足M5及左足HM的峰值压强（PP）高于A组,P＜0.01;B组左足MF的PP低于A组,P＜0.01。3.DM患者双足足底各区域的PP分布无明显差异,大致为：M3＞M4＞HM＞M2,HL＞M5＞M1＞T1＞MF＞T2-5。结论 DPN患者与DM无合并周围神经病变患者的足底压力存在差异。足底压力检测是早期发现DM人群足部物理变化的有效手段。     

Pressure ulcers--randomised controlled trial comparing hydrocolloid and saline gauze dressings

An open comparative randomised study comparing the performance of hydrocolloid dressings (DuoDERM CGF) to saline gauze dressings in the treatment of pressure ulcers was done to evaluate the overall dressing performance, wound healing and cost effectiveness. Thirty-four subjects were enrolled at the University Hospital, Kuala Lumpur over a 643 days period. Inclusion criteria were Stage II or III pressure ulcers, at least 18 years of age and written informed consent. Only one pressure ulcer per subject was enrolled in the study. Patients with infected pressure ulcers, diabetes mellitus, an immuno-compromised status and known sensitivity to the study dressings were excluded. Subjects who met the enrollment criteria were randomised to one of the two dressing regimes. They were expected to participate in the study for a maximum of eight weeks or until the pressure ulcer healed, which ever occurred first. Overall subject age averaged 58 years and the mean duration of pressure ulcer existence was about 1 month. Twenty-one of the thirty-four ulcers enrolled were stage II and thirteen were stage III. The majority of the ulcers (88%) were located in the sacral area and seventeen subjects (50%) were incontinent. In the evaluation of dressing performance in terms of adherence to wound bed, exudate handling ability, overall comfort and pain during dressing removal; all favoured the hydrocolloid dressing by a statistically significant margin (p < 0.001). Subjects assigned the hydrocolloid dressing experienced a mean 34% reduction from their baseline surface area measurement compared to a mean 9% increase by subjects assigned gauze dressings. This was not statistically significant (p = 0.2318). In cost evaluation of the study products, there was no statistical significance in the total cost of wound management per subject. When only labour time and cost was evaluated, there was a statistically significant advantage towards hydrocolloid dressings.     

A comparative study between honey and povidone iodine as dressing solution for Wagner type II diabetic foot ulcers

Honey dressing has been used to promote wound healing for years but scanty scientific studies did not provide enough evidences to justify it benefits in the treatment of diabetic foot ulcers. We conducted a prospective study to compare the effect of honey dressing for Wagner's grade-II diabetic foot ulcers with controlled dressing group (povidone iodine followed by normal saline). Surgical debridement and appropriate antibiotics were prescribed in all patients. There were 30 patients age between 31 to 65-years-old (mean of 52.1 years). The mean healing time in the standard dressing group was 15.4 days (range 9-36 days) compared to 14.4 days (range 7-26 days) in the honey group (p < 0.005). In conclusion, ulcer healing was not significantly different in both study groups. Honey dressing is a safe alternative dressing for Wagner grade-II diabetic foot ulcers.     

糖尿病足保肢的Strauss分级筛选和治疗策略

目的:探讨糖尿病足保肢治疗的病例筛选和治疗方法的选择。方法:采用Strauss分级对60例糖尿病足患者进行筛选,其中A级、B级结合病变特征分成糖尿病缺血性足溃疡、糖尿病神经病变足、糖尿病足合并感染等类型,采用不同的综合治疗方法。结果:A级11例,全部愈合。B级44例,其中39例顺利愈合,3例病情反复、迁延(2个月)愈合,2例迁延不愈(达3个月)行大腿中上段截肢。C级5例全部截肢。总保肢率为88.4%。结论:Strauss分级简单实用,对判断糖尿病足预后十分明了。经典的治疗方法,能达到标本兼治的目的,新的治疗方法目前尚不能广泛开展。     

Effect of biofeedback-assisted relaxation training on foot ulcer healing

A prospective, randomized study was conducted to determine the effect of biofeedback-assisted relaxation training on foot ulcer healing. For patients with chronic nonhealing foot ulcers, medical care was combined with a standardized biofeedback-assisted relaxation training program in the experimental group. The intervention was designed to increase peripheral perfusion, thereby promoting healing. A total of 32 patients with chronic nonhealing ulcers participated in the study. In the experimental group, 14 out of 16 ulcers (87.5%) healed, as compared with 7 out of 16 ulcers (43.8%) in the control group.     

间充质干细胞外泌体联合磺胺嘧啶银乳膏局部外敷治疗糖尿病足溃疡的疗效观察

目的 评估间充质干细胞外泌体(mesenchymal stem cell exosomes,MSC-Exos)联合磺胺嘧啶银乳膏局部外敷对糖尿病足溃疡(diabetic foot ulcers,DFU)愈合的临床疗效。方法 选取2019年1月至2021年6月广东药科大学附属第一医院骨科确诊的糖尿病足溃疡患者25例进行回顾性分析。采用随机数字表法将其分为对照组(n=13)和治疗组(n=12)。对照组行传统外科换药治疗,治疗组采用间充质干细胞外泌体和磺胺嘧啶银乳膏局部外敷,比较两组患者入院时及治疗后第3天、第6天、第9天、第15天创面细菌培养阳性个数,以及第7天、第14天、第21天、第28天创面表面积,记录两组患者创面最终愈合时间。结果 25例患者均进入结果分析,出院后均获得6个月随访。两组患者治疗前创面表面积比较,差异无统计学意义(P>0.05),但在第7天、第14天、第21天、第28天时治疗组创面表面积与对照组相比明显减小,差异均有统计学意义(P<0.05),治疗组最终愈合时间明显短于对照组(P<0.05)。两组患者入院时创面致病菌培养阳性个数比较,差异无统计学意义(...