Diabetic foot is a disease state in which ulcers and gangrene occur in the lower limbs of diabetic patients due to neuropathy that decreases the protective function of the lower limbs, and macrovascular and microvascular lesions that cause inadequate arterial perfusion resulting in impaired microcirculation. It is a serious complication of diabetes mellitus and is one of the major causes of disability and even death in diabetic patients, which not only causes great pain to patients, but also brings a huge economic burden to them. Below, we introduce the treatment of diabetic foot to you.
1.Basic treatment
(1) Absolute prohibition of 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: remove necrotic tissue, routine daily disinfection and drug changes, etc.
(3) Enhance patient education, reasonable foot care as well as prevention of injury from external sources.
(Local debridement)
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. Coupled with the inaccessibility of blood vessels, drugs cannot be effectively transported to the infected site, so the infection is often difficult to control, and sometimes even sepsis occurs. Among the pathogenic bacteria, Staphylococcus aureus is the most common, followed by Streptococcus, Enterococcus, Bacillus and anaerobic bacteria, etc. Among the drug-resistant bacteria, Pseudomonas aeruginosa is more common. Patients should take focal secretions for bacterial culture as soon as possible after admission, first treat with broad-spectrum antibiotics, and then switch to sensitive antibiotics after the culture results.
3.Treatment of peripheral vascular neuropathy
Good control of blood sugar can reduce or mitigate the occurrence and development of peripheral neuropathy. However, there is no reversal effect on the lesion that has already occurred, so it should be prevented and treated early with drugs that improve nerve function and improve microcirculation, mainly aldose reductase inhibitors, inositol, neurotrophic agents and nerve growth factor; prostaglandins, anti-platelet drugs such as cilostazol, anticoagulant drugs such as low molecular heparin and warfarin.
4.Lower limb revascularization surgery for diabetic foot patients
Including lower limb arterial endoluminal intervention (balloon angioplasty, stent implantation), lower limb arterial bypass graft, lower limb distal small arterial bypass graft, lower limb autologous bone marrow stem cell transplantation, etc. Surgical intervention for patients who are clinically proven to be eligible for surgery is still the preferred method for the treatment of peripheral vascular lesions.
(Lower limb revascularization surgery)
5. Treatment of ulcerated wounds
The first type is the ordinary diabetic foot ulcer without combined vascular blockage. This kind of ulcer can generally heal quickly through timely professional dressing change treatment, as well as the cooperation of oral medication and infusion, etc.
The second type is diabetic foot ulcers with blocked blood vessels. These ulcers do not heal because of insufficient blood supply, and if the blood supply to the blood vessels is not improved, the wound will not heal even with the best topical medications. If conservative methods such as stem cell transplantation are too slow to improve the blood supply, it is necessary to first open the blood vessels directly through minimally invasive surgery to ensure that fresh blood can be transported to the foot, and then combine debridement techniques and topical medications to heal the ulcer and preserve the limb.
(Foot ulcer)
6.Maggot debridement treatment (MDT, i.e. biological debridement method)
Biological debridement method refers to the use of living organisms (larvae of green flies) for the treatment of refractory ulcer wounds, including the treatment of diabetic foot wounds with bad maggots. Maggots are fast and effective in wound debridement, and they do not eat the surrounding healthy tissues; they can access deep wounds that are difficult to reach by surgery; maggots have anti-infective effects, especially against Bacillus aeruginosa and many kinds of antibiotic-resistant Staphylococcus aureus (MRSA), etc., which can lead to faster infection control, save a lot of antibiotics, and reduce patients’ medical costs; maggots produce many kinds of growth factors and promote ulcer healing.
(Biological maggots)