Does a diabetic foot ___ have to be amputated?

  With the development of modern society and the change of dietary structure, more and more patients with metabolism-related diseases appear. In 2011, there were 350 million diabetics worldwide, and by 2025, the number of patients may reach 650 million. China has nearly 100 million diabetic patients in 2012. It has now become the world’s number one country for diabetes. With this, the number of patients with diabetes-related complications and their medical costs are increasing year by year, and the prevention and treatment of various complications are receiving more and more attention.  Diabetic foot (DF) is one of the most serious complications of diabetes mellitus due to the combination of neuropathy and various degrees of peripheral vasculopathy, resulting in lower limb infection, ulcer formation and/or deep tissue destruction. According to statistics, 4-10% of diabetic patients have complications with foot disease, which is more common in elderly patients and often requires amputation to save their lives.  Therefore, how to treat diabetic foot ulcers, reduce the rate of amputation caused by this, including endocrinology, vascular surgery, orthopedics and other clinical workers have become the focus of common concern. 1, general treatment: for the lower extremity atherosclerosis occlusive disease of the various treatment measures also apply to the treatment of DMF. Treatment includes appropriate exercise, smoking cessation, antiplatelet therapy, neurotrophic treatment, blood pressure control, lipid control, etc.. Importantly, there is also glycemic control, and good glycemic control can significantly reduce the occurrence of diabetic vascular complications. In a UK Prospective Diabetes Study (UKPDS) in patients with type 2 diabetes, intensive glucose-lowering therapy was shown to reduce overall microvascular complications by 25%, and for every 1% reduction in HbA1c, diabetic complications decreased by 35%. The choice of oral hypoglycemic agents with different mechanisms depending on the patient’s condition should be advocated in combination, which can further reduce HbA1c. Insulin therapy may be more suitable for patients in whom insulin deficiency predominates. In patients with DMF, severe hyperglycemia and even complications such as ketoacidosis and hyperosmolar coma often occur because of infection, and insulin therapy should be preferred for good glycemic control at this time.  However, the current situation is not optimistic. About 5-8% of diabetic patients with foot ulcers require amputation within 1 year. Diabetic foot disease leading to amputation accounts for 50-70% of all lower limb amputation patients, while 85% of diabetic patients with amputation is caused by the complication of foot ulcers. The amputation plane is mostly in the lower leg or thigh.  Happily, we have received very good results in the treatment of diabetic foot by applying the principle of Ilizaro technique based on the “Tissue Retraction Technique”. The procedure is a conventional foot ulcer debridement with the application of the “Tissue Retraction Technique” to the lower leg to promote the healing of the foot ulcer.  If the patient is young, has good blood sugar control, and is compliant with medical treatment, it is possible to delay amputation or even avoid it.  Of course, because the diabetic foot disease itself is complex, this method is not 100% effective, and if it fails, amputation will not affect the overall outcome.