When you see a title like this, some old diabetic patients think: Just kidding, what is diabetes? I already know. Isn’t it just a high level of glucose in the blood that exceeds the normal limit and starts to be excreted out of the body from the urine? What does it have to do with foot ulcers? Actually, it is superficial. Diabetes is a metabolic disorder that causes systemic damage to the body. The process is slow and often takes years of subtlety before manifesting serious consequences. These consequences can be collectively referred to as complications of diabetes, and vascular damage is one of the major damages. When blood vessels are damaged, tissues and organs are not supplied with sufficient nutrients, and a series of problems are bound to occur, which may range from functional insufficiency at the initial stage to necrosis at the severe stage. Elevated blood sugar leads to increased blood viscosity, which can lead to thrombosis in the arteries; excessive sugar in the blood combines with hemoglobin, which can affect the ability of oxygen delivery, leaving tissues and organs in a state of hypoxia; excessive blood sugar leads to an increase in toxic metabolites in the cells, which can damage the cells and affect the function of blood vessels; high blood sugar stimulates intimal hyperplasia, leading to a narrowing of the lumen and a decrease in elasticity, which can seriously affect the blood supply Abnormal glucose metabolism leads to abnormal lipid metabolism, which can lead to the development of atherosclerosis and accelerate its process. Under the combined effect of these factors, the human arterial system can gradually be damaged, affecting the blood supply. The lower extremities are remote areas compared to the heart, with long logistic supply lines, so there are many chances to be affected naturally, and the first manifestation is the problem of the toes, which are located at the “frontier”, and then the whole foot, so the concept of “diabetic foot” emerges: initially, when sleeping at night, the feet feel cold, hot water does not work, and the quilt does not work even if covered overnight; then the calf fatigue when walking, and can only walk and stop; then Later is the lower limb pain; finally is the toe local skin blistering, breaking, infection, ulceration, blackening (gangrene). With the gradual development of the disease, this gangrene from the toe can gradually develop upward, and in severe cases can cause necrosis of the entire limb, which is already life-threatening, and amputation becomes the only measure to save life. According to statistics, diabetic foot hospitalization accounts for 10% of all diabetic inpatients, of which 3% require amputation. 40 times higher amputation rate in age group above 50 years old compared to normal people. So, does a diabetic foot have to be amputated when it appears? Of course not. Amputation is not a solution. Medication for the primary disease is the main measure to slow down the development of vascular lesions. However, if medication is not very effective, vascular surgery methods are also effective. Since diabetic foot is caused by insufficient blood supply to the foot, wouldn’t it be possible to solve the problem by artificially bypassing the blood to the foot? Yes. This is a traditional procedure that has been performed by surgeons for many years. The bridge must be built over the diseased narrowed vessel, from the root of the thigh to the ankle, otherwise the distal blood supply is affected, and generally speaking, the farther the bridge is built, the better the effect of protecting the distal limb. Building a bridge is to engage in construction, where to get the materials? The easiest thing to think of is artificial blood vessels. Over the years, it has been found that artificial blood vessels work well for short distances, but if they are too long, there is a higher chance of blockage due to internal thrombosis; artificial blood vessels are often deflated and cause blockage where they cross the knee joint. Another material is the patient’s own material, and the saphenous vein, which runs the full length of the lower extremity, is ideal. However, it has been found that the saphenous vein has certain disadvantages, namely, it has a small caliber, the blood supply is often not large enough, and in a significant number of patients the saphenous vein itself has problems, making it difficult to obtain the length of a leg. Dr. Freedman of Boston University combined the two materials, using artificial vascular material for the segment above the knee and the saphenous vein for the segment spanning the knee and below the knee, and called it serial bypass, which met the blood supply and reduced the chance of obstruction, with a wide range of adaptations, and was rapidly promoted internationally. In our application, we found that the connector of the two segments of the graft and the distal connector are the key to the procedure, so we made improvements in these two parts. The joint of the two materials was originally connected to the human artery together, but it was changed to an artificial vessel connected to the artery by itself, and then connected to the artificial vessel by the saphenous vein, which is beneficial to improve the local blood flow patency; the joint of the distal ankle was expanded, and the vein accompanying the artery was changed to the direction of blood flow, so that the injection point of the saphenous vein became two points from one point, and the foot stepped on two boats, creating the formation of a common outflow tract technique that drove the blood flow. As the foot regained sufficient blood supply, the dying cells and tissues in the ulcerated area of the toe were quickly revitalized and the ulcer could heal rapidly. Patients feel their feet are much warmer and their calves do not hurt when walking. In the case of necrosis of the toe or part of the foot, of course, it is impossible to revive the dead one, but due to the abundant blood supply, the edge of the necrotic area no longer continues to spread upward, and the demarcation line between normal and abnormal tissues becomes more and more obvious, finally, the necrotic toe can fall off by itself, and when it is difficult to fall off, the necrotic part can be removed surgically, avoiding the high amputation of the “lost leg due to foot” and fully The function of the limb is fully preserved, which is very beneficial to improve the quality of life of the patient.