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Instructions on Diabetic Foot

According to the definition by WHO, diabetic foot is generic terms of foot pain, skin ulcer, acromelic gangrene and other lesions induced by diabetes. It is the kind of foot infection, ulcer and /or deep tissue damage associated with distal nerve abnormalities of lower limbs and peripheral vascular diseases. 

 

Diabetic foot is one of the most common complications of diabetes, and the main cause of disable and death in diabetic patients. The typical symptom of diabetic ulcer is the formation of ulcer after fracture of callus (commonly known as “foot pad”or “callosity”) at repeated compression part. These ulcers are at various sizes or depths, always with concurrent infection or formation of gangrene. The severe cases should be treated with amputation, and the amputation rate is up to 40%. According to statistics, about 15% diabetic patients have ulcers of lower limbs. In China, about 0.9% to 1.7% patients are with foot gangrene, and the incidence of diabetic foot gangrene is about 2.8% to 14.5% in senile patients older than 60 years old. Amputation of lower limbs in diabetic patients accounts for half in all non-traumatic lower limb amputation. If one side of lower limbs is treated with amputation, the other side will have 50% chance to get amputation. After amputation, the mortality rate is about 60% within 5 years for diabetic patients.

The causes of foot diseases are different for diabetic patients, and the two main reasons are:

1. Diabetes can cause peripheral neuropathy, which can induce abnormity of sensory nerve in foot, such as foot numbness, pain or other abnormal sensation, so the foot may not feel the pain stimulus and easily to be hurt. The wound is not treated immediately, and only found until becoming serious, so it has to be amputated.

2. Diabetes can cause peripheral vascular disease, especially vascular lesion of lower limbs----lower limbs are with arteriosclerosis can cause vascular stenosis or obstruction, so it is difficult for foot wound to be healed and easily to form gangrene. The typical symptom of peripheral neuropathy of lower limbs is the intermittent claudication that the patients feel leg pain after walking for some distance and the pain feeling gradually disappears after having a rest. The foot pulse becomes weak or is completely untouched.

 


Diabetic ulcer patients are generally older and with longer duration. Typical performance for diabetic foot ulcers is formation of ulcer after fracture of callus at repeated compression part. These ulcers are at various sizes or depths, always with concurrent infection or formation of gangrene. The surface is covered with necrotic tissues. The primary goal of treatment of diabetic foot ulcers is to heal ulcers as soon as possible, eliminate foot ulcers and reduce the recurrence rate and reduces the risk of patients with lower limb amputations. Principles of treatment of diabetic foot: first is to control infection; second is to treat ischemia, and smooth the blocked revascularization; third is to minimize pressure on the ulcer; and fourth is to take wound preparation and local treatment, in order to remove calluses and improve the situation ulcer wounds.

Compared with conventional topical treatment, VSD technology has following advantages:

1. Take more timely and effective drainage: can take comprehensive drainage, and have good tube patency; the dead space can be rapidly eliminated under high negative pressure.

2. Reduce wound infection: the first principle of treating diabetic foot is to control infection. VSD technology can effectively play the effect of water proof and bacteria proof, in order to reduce infection.

3. Relieve patient’s pain and reduce work load of medical staffs. VSD system does not need to change dressings within 7 to 10 days that can reduce the pain caused by frequent dressing change, and also reduce the work load of medical staffs.

4. The curative time is obviously less than conventional drainage. Ulcer can be healed as soon as possible. Eliminating foot ulcer can decrease the recurrence rate, and the risk of patients with lower limb amputation.

The best way to prevent diabetic patients from foot diseases is to take precautions against diabetic neuropathy or other complications. Now we mainly take measures to control blood sugar. The second is good foot care. For the existing diabetic foot ulcer, physical can give proper antibiotics. If it is only minor infection, the patient can take oral administration of antibiotics; if it is serious, the patient should be admitted to hospital for antibiotic treatment. If there is purulence, ulcer or local tissue necrosis, it is necessary to take surgical debridement.

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