Bandyk Dennis F
Division of Vascular and Endovascular Surgery, University of California-San Diego, 9434 Medical Center Drive, Mail Code 7403, La Jolla, CA 92037.
Semin Vasc Surg. 2018 Jun-Dec;31(2-4):43-48. doi: 10.1053/j.semvascsurg.2019.02.001. Epub 2019 Feb 6.
The pathophysiology of the diabetic foot ulcer and soft-tissue infection is due to neuropathy, trauma, and, in many patients, concomitant peripheral artery occlusive disease. Diabetic neuropathy results in foot deformity, leading to increased skin pressure with walking. Once a foot ulcer develops, the limb is at high risk for invasive infection and, when combined with peripheral artery occlusive disease, the patient should be considered to have critical limb ischemia. A multidisciplinary approach to care for the diabetic foot is recommended, which includes annual (3-month intervals in high-risk patients) assessments by a primary care physician and referral to a podiatrist and vascular surgeon for diabetics with a foot ulcer for evaluation of foot arterial perfusion and off-loading therapy to reduce plantar skin pressure with walking. When invasive foot infection develops and tissue beneath the fascia is involved, inpatient care is recommended for systemic antibiotic therapy, vascular laboratory testing of artery limb perfusion, and surgical debridement of infected tissue. The goals of treatment are to achieve a healed foot and keep the patient ambulatory.
糖尿病足溃疡和软组织感染的病理生理学是由神经病变、创伤引起的，而且在许多患者中还伴有外周动脉闭塞性疾病。糖尿病神经病变会导致足部畸形，从而在行走时增加皮肤压力。一旦足部溃疡形成，肢体就有发生侵袭性感染的高风险，并且当合并外周动脉闭塞性疾病时，应认为患者患有严重肢体缺血。建议采用多学科方法来护理糖尿病足，这包括由初级保健医生进行年度评估（高危患者每3个月评估一次），并将患有足部溃疡的糖尿病患者转诊给足病医生和血管外科医生，以评估足部动脉灌注情况，并进行减负治疗，以减轻行走时足底皮肤的压力。当发生侵袭性足部感染且筋膜下组织受累时，建议住院治疗，进行全身抗生素治疗、对肢体动脉灌注进行血管实验室检测以及对感染组织进行手术清创。治疗的目标是使足部愈合并让患者能够行走。
