1.What is diabetic foot?
A: It is a foot lesion formed on the basis of chronic vascular and neuropathy in diabetic patients.
2.What are the clinical manifestations of diabetic foot disease?
A: There are 5 main clinical manifestations: vascular lesions, neuropathy, biomechanical abnormalities, lower limb ulcer formation, lower limb ulcer infection Liulan, Department of Endocrinology, Nanjing 454 Hospital, PLA
3.What is the relationship between diabetes mellitus and lower limb ischemia?
A: Diabetes often leads to narrowing or complete occlusion of lower limb blood vessels, resulting in insufficient local vascular supply, which is an important cause of diabetic foot.
4.What tests should be done for lower limb vascular ischemia?
Answer.
(1) Lower limb artery palpation: check whether there is local arterial pulsation
(2) Lower limb posture test: Patients with ischemia can see obvious pale skin on the foot after elevating the lower limb for 30-60 seconds.
(3) Ultrasonography: color multispectral (Dopple) is commonly used to examine the vascular condition. It has high sensitivity, specificity and accuracy, and is a non-invasive examination method.
Ankle-brachial index (ABI) = ankle blood pressure/upper arm blood pressure
ABI value Meaning
1.31 or higher Lower extremity atherosclerosis
0.91-1.30 Basically normal
0.71-0.90 Mild lower extremity arteriopathy
0.41-0.70 Moderate lesion
0.40 or less Severe lesions
(4) Arteriography: It can understand the extent of lower extremity vascular lesions, blood flow distribution and the presence of collateral circulation. However, this method is an invasive examination and is generally used only for positioning examination before surgery.
5.What is the clinical classification of diabetic foot disease?
A: There are 5 grades according to the degree of severity.
Grade 0: Foot with risk factors for the occurrence of foot ulcers and no ulcers at present.
Mycobacterial infection between the toes, foot deformity, plantar callus, heel cracking, etc.
Grade 1: superficial ulcers, clinically uninfected
Grade 2: deeper ulcer, often combined with soft tissue inflammation, no abscess or infection of the bone
Grade 3: deep infection with bone histopathy or abscess
Grade 4: limited gangrene (toe, heel or forefoot dorsum)
Grade 5: gangrene of the whole foot
6, the daily care of the foot of diabetic patients
A: A foundation: good control of blood sugar, so that glycated hemoglobin <6.5%;
Two help.
(1) ask others to help, if there is a visual impairment, or should not be operated personally, you should ask others to help, check the foot, cut toenails, repair calluses (cut toenails: cut toenails after washing the feet when they are soft; cut flat, do not cut too short; do not repair the edges into round or angled);
(2) ask for medical help, if there is painful blistering of the foot, you must go to the hospital;
Three must.
(1) wash feet twice: warm water (less than 40 ℃), 15 to 30 minutes / time, to avoid burns, and gently dry the seam between the toes;
(2) shoes and socks check: socks: no holes, pilling, wool socks or cotton socks (shoes: the size should be appropriate, loose, not just fit the foot. Cloth shoes, avoid hard leather shoes) ;
(3) View: blisters, scratches or breaks. If necessary, use a mirror to view the sole of the foot itself
Four should not.
(1) do not smoke to prevent nicotine induced and aggravated by the disease; weight loss, control hyperlipidemia, hypertension ;
(2) do not walk barefoot, especially on the beach or in the pool, to prevent injury;
(3) Do not use chemical agents to eliminate corns or calluses, and should not use adhesive tape on the feet ;
(4) should not use hot water bags or fireplace to warm the feet, winter can wear fine wool socks to keep warm;
Foot exercise: lifting heel – toe exercise, bending knee – squat exercise, shaking leg exercise, 30 minutes
7.What is biological debridement method?
A: It is the method of using live species of organisms (maggots) for the treatment of refractory ulcer wounds, including the treatment of diabetic foot gangrene wounds. Medical maggots are the first living organisms approved by the FDA that can be used in humans. There are few domestic studies, and none in the southern region except Nanjing.
8.What is the superiority of maggot therapy?
A: There are three major advantages: (1) maggots clean wounds quickly and well, will not eat the surrounding healthy tissue, it can enter the deep wounds that are difficult to reach surgically; (2) maggots have anti-infective effects, especially for a variety of antibiotic-resistant Staphylococcus aureus (MRSA), the infection can be faster control; (3) maggots can produce a variety of growth factors, to promote ulcer healing.
9.Will maggot therapy be unclean?
A: No. All maggots have to undergo strict sterilization before they can be applied to human wounds.