The ulcer lesion in diabetic foot is a major complication and usually leads to disability. Current treatments composed mostly of medication or amputation if required. After the conference of Vietnamese -American on diabetic foot care in June 2000, we have established a new plan of management, included early operation, proper debridement and appropriate blood sugar control. Method and material: retrospective and cross sectional study on 16 type II diabetics (5 males and 11 females) with foot infection. All these patients were operated to remove dead bones and necrotic tissues, sutured the wound in one layer and immobilized the pain leg within 21 days. They were also treated with insulin and investigated the arterial system by Doppler ultrasound. Results: average age of patients: 562 years. Average glycemia: 19020mg%. Left foot: 9. Right foot: 6. Both feet: 3. The duration from onset to ulcer: 60.2 years. Doppler ultrasonography showed the decrease flow pattern of lower limbs in 14 cases, atherosclerosis: 2. After surgery, 11 patients were healed completely within 21 days, 3 others within 30 days and 2 patients had to be amputated
Diabetic Foot ; surgery

Diabetic Foot ; surgery ; Humans ; Vascular Surgical Procedures ; methods

Diabetic foot ulcers (DFUs) is a severe complication of the diabetes mellitus, which is the first leading cause of non-traumatic lower limbs amputations. The pathogenesis of diabetic foot involves a variety of mechanisms, treatment involves the department of foot and ankle surgery, department of vascular surgery, endocrinology, and infection control. Treatment need multidisciplinary diagnosis and treatment. Debridement is the basis of treating diabetic foot ulcers, and the normal anatomical structure should be maintained during the process. Vacuum sealing drainage (VSD) and antibiotic-laden bone cement (ALBC) have more advantages of controlling infection and ulceration wound healing, which could receive good clinical effect. Tendon lengthening could alleviate the problem of ulcer occurrence and progression caused by stress concentration on the bottom of foot, which has widely application and has advantages of preventing formation of foot ulcers. Flap transplantation could solve the problem of wound healing, but it is necessary to consider whether the transplanted flap could bear the same function as plantar tissue. Tibial bone transverse distraction is a relatively new technique, and the mechanism is not clear, but it has certain application prospects from the perspective of clinical efficacy.
Debridement ; Diabetes Mellitus ; Diabetic Foot/surgery* ; Foot Ulcer ; Humans ; Salvage Therapy ; Wound Healing

A 68-year-old female patient was treated for unhealed ulcer in the fourth toe of the left foot. Clinical examinations identified severe stenosis of the proximal segment and occlusion of the distal segment of the left anterior tibial artery, and occlusion of the left posterior tibial artery and the peroneal artery. The proximal stenotic segment of the left anterior tibial artery was dilated, but the distal occlusive part failed to be re-canalized. Left anterior tibial artery to dorsal pedal artery bypass was performed on the patient with an epoxide-crosslinked, special radicals antigen-sealed, porcine-derived biological graft; debridement of the left 4th digiti pedis was also performed. Postoperation course was uneventful. The pulse of the left dorsal pedal artery was strong. The ankle brachial index (ABI) increased from 0.60 to 1.09. Warfarin and two antiplatelet drugs were given after the operation. Six months after operation, computed tomographic angiogram (CTA) identified the patent graft.
Aged ; Blood Vessel Prosthesis ; Diabetic Foot ; surgery ; Female ; Humans ; Ischemia ; surgery ; Leg ; blood supply

OBJECTIVETo investigate the feasibility of debridement at early stage by combining lavation and drainage under continuous negative pressure in the limb salvage surgery of patients suffering from diabetic foot complicated by plantar abscess.

METHODSTen patients suffering from diabetic foot (10 feet affected) combined with plantar abscess were involved. After being debrided, wounds of patients were lavaged and drained for 7 - 14 ds under continuous negative pressure through a detained stomach tube. Suction under negative pressure continued for 3 - 5 ds after lavation, and then drainage tube was removed. Stitches on wound were removed about 3 weeks after surgery. The condition of the wounds was observed.

RESULTSAfter above-mentioned treatment, local inflammatory response of patients was obviously ameliorated, and the wounds healed with satisfactory preservation of function and shape of the feet.

CONCLUSIONSDebridement combined with local lavation and drainage under continuous negative pressure is satisfactory for the treatment of diabetic foot complicated by plantar abscess, and it can preserve the length of the affected limb.

Abscess ; complications ; surgery ; Aged ; Bacterial Infections ; complications ; surgery ; Debridement ; Diabetic Foot ; complications ; surgery ; Feasibility Studies ; Female ; Foot Ulcer ; complications ; surgery ; Humans ; Male ; Middle Aged ; Negative-Pressure Wound Therapy

OBJECTIVETo investigate the clinical rules of amputation for diabetic foot and analyse the perioperative problems.

METHODSThirty-two patients with diabetic foot included 25 male and 7 female with an average age of 65.1 years, ranging from 51 to 78 years. All of them had amputation on single side. Among them, 23 patients underwent amputation once, 8 patients had twice, 1 patient had three times.

RESULTSThe patients were followed-up for 6 months to 1 year (average 8 months). Two cases complicated with postoperative infection and gave up therapy, the other 30 cases gained wound healing finally and pain relief, recovery to normal life and work.

CONCLUSIONPrevention and active treatment is the key for the diabetic foot. For the refractory infection the proper and correct amputation is necessary.

Aged ; Amputation ; Diabetic Foot ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVE: To investigate the effectiveness of tibial transverse transport (TTT) combined with modified neurolysis in treatment of diabetic foot ulcer (DFU) through a prospective randomized controlled study. METHODS: The patients with DFU and diabetic peripheral neuropathy, who were admitted between February 2020 and February 2022, were selected as the research objects, of which 31 cases met the selection criteria and were included in the study. The patients were divided into two groups by random number table method. The 15 patients in the trial group were treated with TTT combined with modified neurolysis, and the 16 patients in the control group received treatment with TTT alone. There was no significant difference in gender, age, duration of DFU, ulcer area, Wagner classification, as well as preoperative foot skin temperature, visual analogue scale (VAS) score, ankle-brachial index (ABI), motor nerve conduction velocity (MNCV) of the common peroneal nerve, MNCV of the tibial nerve, MNCV of the deep peroneal nerve, two-point discrimination (2-PD) of heel, and cross-sectional area (CSA) of the common peroneal nerve between the two groups ( P>0.05). The time for ulcer healing, foot skin temperature, VAS scores, ABI, 2-PD of heel, and CSA of the common peroneal nerve before operation and at 6 and 12 months after operation were recorded and compared between groups. The differences in MNCV of the common peroneal nerve, MNCV of the tibial nerve, and MNCV of the deep peroneal nerve between pre-operation and 12 months after operation were calculated. RESULTS: All patients in both groups were followed up 12-24 months (mean, 13.9 months). The surgical incisions in both groups healed by first intention and no needle tract infections occurred during the bone transport phase. Ulcer wounds in both groups healed successfully, and there was no significant difference in the healing time ( P>0.05). During the follow-up, there was no ulcer recurrences. At 12 months after operation, the MNCV of the common peroneal nerve, the MNCV of the tibial nerve, and the MNCV of the deep peroneal nerve in both groups accelerated when compared to preoperative values ( P<0.05). Furthermore, the trial group exhibited a greater acceleration in MNCV compared to the control group, and the difference was significant ( P<0.05). The foot skin temperature, VAS score, ABI, 2-PD of heel, and CSA of the common peroneal nerve at 6 and 12 months after operation significantly improved when compared with those before operation in both groups ( P<0.05). The 2-PD gradually improved over time, showing significant difference ( P<0.05). The 2-PD of heel and VAS score of the trial group were superior to the control group, and the differences were significant ( P<0.05). There was no significant difference in ABI, foot skin temperature, and CSA of the common peroneal nerve between groups after operation ( P>0.05). CONCLUSION Compared with TTT alone, the TTT combined with modified neurolysis for DFU can simultaneously solve both microcirculatory disorders and nerve compression, improve the quality of nerve function recovery, and enhance the patient's quality of life.
Humans ; Diabetic Foot/surgery* ; Microcirculation ; Prospective Studies ; Quality of Life ; Treatment Outcome ; Diabetes Mellitus

OBJECTIVETo study the effects of negative-pressure wound therapy (NPWT) on the treatment of complicated and refractory wounds.

METHODSSixty-seven patients with complicated or refractory wounds admitted to our hospital from September 2005 to November 2008 were randomly divided into NPWT group (n = 35) and conventional treatment (CT) group (n = 32). Wounds of patients in NPWT group were treated with interrupted suction under a pressure of -16.63 kPa for 24 hs, or continuous suction under a pressure of -10.64 kPa for 24 hs. Wounds of patients in CT group were covered with petrolatum gauze overlaid with isotonic saline gauze and dry gauze. Duration of treatment, times of operation, treatment cost, and the process of healing were compared between two groups.

RESULTSThe duration of treatment, treatment cost and times of operation of patients in NPWT group were obviously less or fewer than those of CT group (P < 0.05). Wounds of patients in NPWT group were mainly healed by themselves (40.0%) or healed after free skin grafting (40.0%). While wounds in patients in CT group healed mainly after tissue flap transplantation (66.7%) or free skin grafting (23.3%).

CONCLUSIONSCompared with CT, NPWT can shorten the length of hospital stay, reduce operation frequency and treatment cost, and it is easier to carry out in the surgery of treating complicated and refractory wounds, which is worth generalization.

Adult ; Aged ; Diabetic Foot ; surgery ; Female ; Humans ; Male ; Middle Aged ; Negative-Pressure Wound Therapy ; Pressure Ulcer ; surgery ; Wound Healing

INTRODUCTIONThis is the fi rst prospective study done locally to determine the effectiveness of vacuum-assisted closure (VAC) therapy in the healing of chronic diabetic foot ulcers.

MATERIALS AND METHODSAn electronic vacuum pump was used to apply controlled negative pressure evenly across the wound surface. Changes in wound dimension, presence of wound granulation and infection status of diabetic foot ulcers in 11 consecutive patients with diabetes were followed over the course of VAC therapy.

RESULTSHealing was achieved in all wounds. Nine wounds were closed by split-skin grafting and 2 by secondary closure. The average length of treatment with VAC therapy was 23.3 days. Ten wounds showed reduction in wound size. All wounds were satisfactorily granulated and cleared of bacterial infection at the end of VAC therapy.

CONCLUSIONSVAC therapy was useful in the treatment of diabetic foot infection and ulcers, which after debridement, may present with exposed tendon, fascia and/or bone. These included ray amputation wounds, wounds post-debridement for necrotising fasciitis, wounds post-drainage for abscess, a heel ulcer and a sole ulcer. It was able to prepare ulcers well for closure via split-skin grafting or secondary closure in good time. This reduced cost of VAC therapy, as therapy was not prolonged to attain greater reduction in wound area. VAC therapy also provides a sterile, more controlled resting environment to large, exudating wound surfaces. Large diabetic foot ulcers were thus made more manageable.

Adult ; Debridement ; Diabetic Foot ; classification ; surgery ; therapy ; Female ; Humans ; Male ; Middle Aged ; Negative-Pressure Wound Therapy ; Prospective Studies ; Wound Healing

INTRODUCTIONThis study aims to evaluate the predictive factors affecting the clinical outcome of Below Knee Amputations (BKA) performed in diabetic foot patients admitted to National University Hospital (NUH) Multi-Disciplinary Diabetic Foot Team.

MATERIALS AND METHODSThis is a prospective cohort study of 151 patients admitted to the Department of Orthopaedic Surgery, NUH, for Diabetic Foot Problems (DFP) from January 2006 to January 2010. All had undergone BKA performed by NUH Multi-Disciplinary Diabetic Foot Team. Statistical analyses (univariate and multivariate analysis with logistic regression) were carried out using SPSS version 18.0, for factors such as demographic data, diabetic duration and control, clinical findings and investigations, indications for surgery, preoperative investigations and evaluation, microbiological cultures, and these were compared to the clinical outcome of the patient. A good clinical outcome is defined as one not requiring proximal re-amputation and whose stump healed well within 6 months. The ability to ambulate with successful use of a prosthesis after 1 year was documented. Statistical significance was set at P <0.050.

RESULTSMean age of study population was 55.2 years with a male to female ratio of about 3:2. Mean follow up duration was 36 months. Of BKAs, 73.5% gave a good outcome. Univariate analysis showed that smoking, previous limb surgery secondary to diabetes, high Total White Count (TW), Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), Urea, Creatinine (Cr), Neutrophils, absence of posterior tibial and popliteal pulses, low Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) were associated with poor clinical outcome. Multivariate analysis showed that high CRP, ESR, Neutrophils, absence of popliteal pulse and low ABI were associated with poor clinical outcome. Of patients, 50.3% attained mobility with prosthesis after 1 year. Mortality rate was 21.2% within 6 months of operation, with sepsis being the most significant cause of death.

CONCLUSIONSuccess rate of BKA was 73.5%, with mortality rate being 21.2% within 6 months. In this cohort, 50.3% were able to attain eventual mobility with prosthesis after 1 year. Sepsis was the most significant cause of death. Markers of infection such as high CRP, ESR, neutrophils; and indicators of poor vascularity such as absence of popliteal pulse and low ABI were significantly associated with poor clinical outcome.

Adult ; Aged ; Aged, 80 and over ; Amputation ; methods ; Diabetic Foot ; surgery ; Female ; Humans ; Knee ; Male ; Middle Aged ; Prospective Studies ; Treatment Outcome