Today is a holiday that belongs to our doctors. First of all, I would like to wish all dedicated medical professionals a happy holiday! Also, I would like to thank the whole society for the respect and recognition of the profession of physicians. However, Physicians’ Day is not just used to celebrate. I think the reason for establishing Physician’s Day is not only to respect and care for doctors and to promote self-regulation in the profession, but also, more importantly, to lead us to discuss and think about the hot issues of the day. I am a diabetic foot specialist, and today I would like to talk about the issue of diabetic foot amputation in the hope that I can share this with my colleagues. I have found that most of the patients who are advocated for amputation do not actually have to have their limbs amputated at all. Why amputation? I think it is mainly related to the following “obstacles”. The first obstacle: infection control obstacle Infection is a major feature of diabetic foot, infection cannot be controlled, germs continue to grow, and more healthy tissues are destroyed, which is one of the main reasons why diabetic foot cannot be cured. According to our patient summary found that the main method of infection control is still the use of antibiotics, one does not work with two, two does not work and then add other kinds of antibiotics, domestic does not work and then use imported —— With the continuous updating of antibiotics, the phenomenon of unreasonable use of antibiotics is increasing, and the resistance of pathogenic bacteria to antibiotics is changing more and more rapidly. This results in the infection just not being controlled, no matter what the doctor does. And once the infusion is stopped and the antibiotics are discontinued, the infection is like water that breaks the dike and becomes uncontrollable, rapidly moving up the infection to destroy more tissue. In order to save their lives, they have no choice but to cut it off. The second stalk: wound treatment stalk Timely and effective wound treatment, one is conducive to the control of infection, the second is conducive to wound healing. If not treated or improperly treated, it will lead to aggravation of diabetic foot, and doctors will choose to amputate as soon as possible. Diabetic foot is often accompanied by wound breakdown, especially severe wet gangrene, the impact of the ulcerated wound is no less than that of a highly decomposed corpse, and the pungent stench emitted by the pus makes people feel like suffocating. In most of our patients, the inflammatory wounds are relatively “intact” and have not been touched or debrided by the physician. Faced with such a wound, many doctors are afraid to avoid it, so who would be willing to do the wound treatment? On the other hand, since people do not have professional training in trauma ostomy, even if doctors are willing to clear the trauma, it is only a slapdash treatment, which does not achieve the purpose of clearing the trauma. Sometimes, the more the wound is cleared, the more serious it becomes, and eventually the limb is amputated. The third obstacle: the responsibility of the obstacle Diabetic foot is a multi-organ, multi-tissue disease complex involving the heart, brain, kidneys, etc., long-term failure to control the infection, a large number of toxins absorbed by the body, will organ failure or even the risk of death. Faced with this situation, especially in the current situation of tension between doctors and patients, it is inevitable that some doctors will be reluctant to accept patients with diabetic foot, after all, the cure is no longer the priority, the main thing is not to have an accident. Doctors may say they can’t cure it and suggest transferring it to another hospital. This reminds me of a quote from He Jianyi in “The Emergency Physician”: If we doctors are afraid to take responsibility, then who will treat and save people? However, diabetic foot patients have complex physical conditions, the treatment process is cumbersome, and in most cases, the treatment will get worse and worse, and eventually they will face amputation. Instead of going through the trouble, more people would choose to amputate the limb from the beginning, avoiding any possible trouble or accidents in the middle. The fourth obstacle: the doctor’s “heart” obstacle First, for example, there was a patient with dry gangrene who returned from Canada for treatment, and when he visited an authoritative hospital in Nanjing for the treatment of diabetic foot, an expert-level doctor told him that his chances of limb preservation were basically zero. Later, when the family consulted them about conservative treatment with Chinese and Western medicine, the doctors directly said not to believe it. Because, they think there is no Chinese and Western medicine for diabetic foot in the guide, but there is amputation in it. The method that is not there is false, and the method that is there is true. There is no doubt that medical guidelines provide an important basis and reference for our clinical work and are conducive to the standardization and unification of medical practice, which is certainly very significant. However, the problem is that many guidelines are immature or imperfect, and we also believe and rely on them too much. At present, diabetic foot treatment is mostly scattered in diabetes-related guidelines, and amputation of diabetic foot is one of the conventional treatments in these guidelines, and parameters and criteria such as amputation position and amputation plane have been established. The guidelines say that the diabetic foot needs to be amputated, so if we follow the guidelines, the doctor’s choice is not wrong, and we are not responsible for the accident. These guidelines happen to have no section on limb preservation in Chinese and Western medicine, which inevitably leads to people being blind to the fact that “no amputation”. Sometimes I feel that doctors have closed themselves off in a small space and only believe in what they believe in. They are not willing to understand, learn, and explore areas that they do not understand, even if the facts are there. Amputation has become an expert consensus, a guide for everyone, and the gold standard gold method. However, amputation has also become a knot in everyone’s heart. If this knot is untied, it is believed that more patients will avoid the fate of amputation and the diabetic foot treatment will be better developed and improved. Therefore, not only on this day of Physicians’ Day, but also in every day of clinical work in the future, we doctors in the diabetic foot industry should work together, work together, communicate, learn and share advanced technology, reduce the rate of amputation of diabetic foot, and strive to let more diabetic foot patients not lose the right to walk freely.