Department of Plastic Surgery, Georgetown University Hospital, Washington, District of Columbia.
Semin Plast Surg. 2010 Feb;24(1):43-56. doi: 10.1055/s-0030-1253239.
The diabetic triad of neuropathy, vasculopathy, and foot deformity can be surgically challenging to the reconstructive surgeon. Soft tissue deficits must be closed to protect underlying structures from infection and to provide a stable environment for healing. It is critical to have adequate blood flow and to debride the wound to clean healthy tissue before considering reconstruction. Surgical options commonly used include healing by secondary intention, local flap closure, skin grafts, pedicled flaps, and free tissue transfer. Despite a surgeon's best operative efforts, these strategies may fail perioperatively due to postoperative shear forces created by premature joint motion and/or pressure (either weight bearing or decubitus). In the properly selected patient population, external fixators serve as an indispensable adjunct to wound healing in the Charcot foot by providing temporary but reliable offloading and/or immobilization of joints. Using a team approach is critical to the success of diabetic limb reconstruction.
糖尿病三联征（神经病变、血管病变和足部畸形）可能给重建外科医生带来手术挑战。必须闭合软组织缺损，以保护深部结构免受感染，并为愈合提供稳定的环境。确保有足够的血流并清创伤口，以清除健康组织，这一点至关重要。常用的手术选择包括二期愈合、局部皮瓣闭合、植皮、带蒂皮瓣和游离组织转移。尽管外科医生进行了最佳的手术操作，但由于术后关节过早运动和/或压力（负重或压疮）引起的剪切力，这些策略可能会在围手术期失败。在选择合适的患者人群中，外固定器通过为夏科足提供临时但可靠的关节减压和/或固定，成为创面愈合不可或缺的辅助手段。采用团队方法对于糖尿病肢体重建的成功至关重要。
