The pathological basis of diabetic foot is the occlusion of small and medium-sized blood vessels caused by long-term hyperglycemia, and then tissue ischemia and necrosis. Therefore, the treatment of diabetic foot is based on good control of blood sugar, and in addition, specialized treatment should be done for peripheral vascular lesions. The prevention and treatment goal of diabetic foot is prevention-oriented, early diagnosis and early treatment, which not only can significantly improve the quality of life of diabetic patients, but also can greatly reduce the related medical expenses, which has important social and economic benefits.
1.Basic treatment
(1) Absolute abstinence from smoking, weight control, strict control of blood sugar, insulin application is preferable, active correction of ketoacidosis, heart, brain, kidney complications and various adverse factors affecting the healing of gangrene.
(2) Local debridement: removal of necrotic tissue, daily routine disinfection and dressing changes, etc.
(3) Strengthen patient education, reasonable foot care and prevention of external injuries.
2.Anti-infection treatment
Diabetic foot is highly susceptible to infection due to tissue ischemia and reduced resistance, as well as being in a high glycemic state. Due to the inaccessibility of blood vessels, drugs cannot be effectively transported to the infection site, so the infection is often difficult to control, and sometimes even sepsis occurs. Among the pathogenic bacteria, Staphylococcus aureus is common, followed by Streptococcus, Enterococcus, Bacillus and anaerobic bacteria, etc. Among the drug-resistant bacteria, Pseudomonas aeruginosa is more common. After admission, take the secretion of the lesion for bacterial culture as early as possible, treat with broad-spectrum antibiotics first, and change to sensitive antibiotics after the culture result.
3.Treatment of ischemic foot ulcer
(1) For those whose vascular lesions are not very serious or without surgical indications, conservative medical treatment can be adopted and vasodilator drugs can be used.
(2) For those with severe vascular lesions, on the basis of conservative treatment, interventional therapy, i.e., endoluminal revascularization, should be performed to regain blood supply to the distal ischemic tissues. The arterial condition of the lower extremity must be accurately evaluated before interventional treatment so that the physician can adequately prepare and achieve a successful procedure.
Previously, diabetic infrapopliteal vasculopathy was too small for surgeons to do anything about. However, with the rapid development of vascular surgery, the DEEP infrapopliteal vascular lesion is now available.
However, with the rapid development of vascular surgery, the DEEP subknee microballoon is now being used to dilate and shape the subknee vessels of the affected limb (including the arteries of the foot) with significant clinical improvement and great success. Intraluminal angioplasty of small infrapopliteal arteries has now become a routine treatment in vascular surgery.
(3) For patients with gangrene who have pain at rest and extensive vascular lesions that cannot be revascularized, toe amputation or amputation should be performed if necessary, and patients who already have limb necrosis should have their limbs amputated promptly after the plane of necrosis is clear. Patients with suprapatellar arteriopathy need to undergo arterial balloon dilation + stent implantation before amputation to open the vessels and avoid the amputation incision from healing due to ischemia.
4.Treatment of neuropathic foot ulcers
(1) Change the abnormal stress on the foot 90% of neuropathic ulcers can be healed by reasonable conservative treatment. The key to treatment is to reduce the pressure caused by the primary disease, understand the pressure distribution through foot manometry, and then use special orthopedic shoes or
Special orthopedic shoes or orthoses are then used to modify the pressure in the patient’s foot.
(2) Improve nerve function B vitamins and nerve growth factors are available to promote nucleic acid and protein synthesis in nerve cells and myelin formation for axonal regeneration.
(3) Covering dressing Dressing can prevent further damage to the wound, reduce the risk of infection, and maintain the ideal environment for wound healing. Wet dressing can be chosen to improve the growth rate.
5. Amputation
Active treatment still occurs gangrene of the limb, should be promptly amputated, amputation site should be accurately estimated, local circulation should be made to choose, to ensure good circulation height. The mortality rate of amputation due to diabetic foot artery occlusion is high, so it should be treated actively as early as possible to avoid the surgical risk of amputation.