The importance of specialized treatment for diabetic foot disease

  Diabetic foot and its ulcers are one of the common chronic comorbidities of diabetes mellitus, which is the main cause of amputation and disability in diabetic patients. The Department of Surgery of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, under the leadership of Professor Wang Jun, the leader of the discipline, through years of clinical experience and a large sample of clinical research on diabetic foot ulcers in the “Eleventh Five-Year Plan” National Key Support Science and Technology Project, has summarized a comprehensive external treatment plan for diabetic foot ulcers and established a perfect intervention system for diabetic foot disease screening It has established a comprehensive intervention system of diabetic foot disease screening, monitoring, treatment and rehabilitation, which can greatly reduce the severity of diabetic foot ulcers, reduce the disability rate and improve the quality of life of patients.  The following characteristics can be found from the medical history of severe diabetic foot ulcers (ulcers of grade III, IV and V) admitted to the Department of Surgery of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine in recent years: 78% of patients had a history of diabetes for more than 10 years; 82% of patients had unsatisfactory glycemic control and glycosylated hemoglobin of more than 8% at the time of admission; 67% of patients had obvious symptoms of lower limb ischemia for more than 1 year; Eighty-five percent of patients had a foot rupture prior to admission; only 11% of patients had been surgically diagnosed and correctly treated for diabetic foot.  Diabetic podiatry studies have generally concluded that the main manifestations of diabetic podiatry are local neurological abnormalities and peripheral vasculopathy in the distal lower extremities, with insidious onset until the patient is diagnosed with cold, numbness, pain or even foot breakdown and gangrene. However, at this time the disease is mostly advanced and the gangrene is uncontrollable and leads to amputation. During the history taking we often find that non-diabetic foot specialists also know little about diabetic foot and have many misconceptions: firstly, they do not understand that diabetic foot and ulcers are arterial ischemic ulcers and often confuse diabetic foot, thrombo-occlusive vasculitis and venous ulcers of the lower limbs and cannot distinguish between arterial and venous disease; secondly, they cannot perform basic examination and assessment of diabetic foot patients; nor do they rely on There is also no experience in applying and adjusting anticoagulant drugs to treat diabetic foot patients based on laboratory tests such as clotting time, D-dimer, and platelet damage; furthermore, the ulcers can only be treated with simple antiseptic changes and dilation, sometimes counterproductively aggravating gangrene.  The diabetic foot is a vascular disease that poses a serious threat to public health and quality of life, and intervention with professional experience plays an important role in its prevention, treatment and rehabilitation. Physicians with extensive experience in the treatment of diabetic foot and related scientific research have the understanding that “prolonged diabetes must be accompanied by vascular disease”, and are alert enough to diabetic peripheral vascular disease of the lower extremities, and treatment does not only stop at the level of blood glucose control, but also makes regular screening of vascular disease and basic drug treatment a must.