Ilonzo Nicole, Patel Munir, Lantis John C
Surgical Department, Mount Sinai St. Luke's - West Hospitals, New York, New York.
Vice Chairman of General Surgery, Director of Surgical Clinical Research, Mount Sinai St. Luke's - West Hospitals, New York, New York.
Surg Technol Int. 2018 Jun 1;32:49-59.
Diabetes Mellitus is a serious systemic illness that has an epidemic-like increasing prevalence in the United States, as well as the rest of the world. With the increasing number of people with diabetes comes the higher incidence of diabetes-related complications. One of these known complications, diabetic foot ulcers (DFU), has an estimated lifetime incidence of 15% in diabetics. Having a DFU increases the risk of infection, amputation, and even death, which is why prompt treatment and surveillance of such ulcers is imperative. Multiple organizations and journals have recently published best practices to heal and close DFU. Despite these guidelines, it is estimated that only 50% of all diabetic foot ulcers close within one year in the United States. To further confuse this picture, many trials include postoperative wounds that behave in a very different way than chronic wounds. The management of diabetic ulcers requires an understanding of not only the pathophysiology along with a multi-modal approach involving local wound care, pressure prevention, infection control, and, in some, revascularization, but also how care is delivered in the United States presently. In this review, we hope to elucidate the current knowledge and modalities used in ulcer management and to focus on key areas and best practices to inform the clinician, both in what they should do and what they can do.
糖尿病是一种严重的全身性疾病，在美国以及世界其他地区，其患病率正呈流行趋势上升。随着糖尿病患者数量的增加，糖尿病相关并发症的发病率也随之升高。其中一种已知的并发症——糖尿病足溃疡（DFU），在糖尿病患者中的终生发病率估计为15%。患有糖尿病足溃疡会增加感染、截肢甚至死亡的风险，这就是为何对此类溃疡进行及时治疗和监测至关重要的原因。多个组织和期刊最近都发表了治愈和闭合糖尿病足溃疡的最佳实践方法。尽管有这些指南，但据估计，在美国，所有糖尿病足溃疡中只有50%能在一年内愈合。更让人困惑的是，许多试验纳入的术后伤口与慢性伤口的表现截然不同。糖尿病溃疡的管理不仅需要了解病理生理学以及采用包括局部伤口护理、预防压力、控制感染以及在某些情况下进行血管重建的多模式方法，还需要了解目前美国的护理方式。在本综述中，我们希望阐明溃疡管理中目前所使用的知识和方法，并聚焦关键领域和最佳实践，以便为临床医生提供指导，告知他们应该做什么以及能够做什么。
