Department of Endocrinology, University Hospital of Skåne (SUS), 205 02, Malmö, Sweden.
Endocrine. 2012 Jun;41(3):384-97. doi: 10.1007/s12020-012-9619-x. Epub 2012 Feb 25.
Every 30 s, a lower limb is amputated due to diabetes. Of all amputations in diabetic patients 85% are preceded by a foot ulcer which subsequently deteriorates to a severe infection or gangrene. There is a complexity of factors related to healing of foot ulcers including strategies for treatment of decreased perfusion, oedema, pain, infection, metabolic disturbances, malnutrition, non-weight bearing, wound treatment, foot surgery, and management of intercurrent disease. Patients with diabetic foot ulcer and decreased perfusion do often not have rest pain or claudication and as a consequence non-invasive vascular testing is recommended for early recognition of ulcers in need of revascularisation to achieve healing. A diabetic foot infection is a potentially limb-threatening condition. Infection is diagnosed by the presence or increased rate of signs inflammation. Often these signs are less marked than expected. Imaging studies can diagnose or better define deep, soft tissue purulent collections and are frequently needed to detect pathological findings in bone. The initial antimicrobial treatment as well as duration of treatment is empiric. There is a substantial delay in wound healing in diabetic foot ulcer which has been related to various abnormalities. Several new treatments related to these abnormalities have been explored in wound healing with various successes. An essential part of the strategy to achieve healing is an effective offloading. Many interventions with advanced wound management have failed due to not recognizing the need for effective offloading. A multidisciplinary approach to wounds and foot ulcer has been successfully implemented in different centres with a substantial decrease in amputation rate.
每 30 秒，就有一条腿因糖尿病而截肢。在糖尿病患者的所有截肢中，85%是由足部溃疡引起的，而足部溃疡随后会恶化成严重的感染或坏疽。足部溃疡的愈合涉及到许多与治疗相关的复杂因素，包括改善灌注、水肿、疼痛、感染、代谢紊乱、营养不良、非负重、伤口处理、足部手术以及并发症管理等策略。患有糖尿病足溃疡和灌注不足的患者通常没有静息痛或跛行，因此建议进行非侵入性血管检查，以早期发现需要血管重建以实现愈合的溃疡。糖尿病足感染是一种潜在的威胁肢体的疾病。感染的诊断依据是炎症迹象的存在或增加。这些迹象通常比预期的要不明显。影像学研究可以诊断或更好地定义深部软组织脓性积聚，并经常需要检测骨骼的病理发现。初始的抗菌治疗和治疗持续时间是经验性的。糖尿病足溃疡的愈合延迟相当严重，这与各种异常有关。为了治疗这些异常，已经在伤口愈合方面探索了几种与这些异常相关的新治疗方法，取得了不同程度的成功。实现愈合的策略的一个重要部分是有效减压。许多先进的伤口管理干预措施因未能认识到有效减压的必要性而失败。多学科方法在不同的中心成功地应用于伤口和足部溃疡，显著降低了截肢率。
