Robson M C, Edstrom L E
Surg Clin North Am. 1977 Oct;57(5):1089-1102. doi: 10.1016/s0039-6109(16)41344-7.
Of the complications of diabetes mellitus, none is more devastating than gangrene of the foot and the threat of leg amputation. The pathophysiology of vascular insufficiency, neurotrophic changes, and infection leading to this gangrene have been reviewed. Based on this pathophysiology, an approach for conservative surgery of the diabetic foot has been outlined. Using known principles of wound healing and the management of soft tissue infection, obviously necrotic or infected tissue is debrided and the wound managed conservatively. The use of debriding adjuncts such as the pulsating jet lavage, topical antibacterials, and biologic dressings are suggested to control the infection so that the wounds can be closed with either skin grafts or local flaps. This method can result in salvage of many feet and the maintenance of biped ambulation since the outlook for the diabetic with a major amputation is markedly different from the nondiabetic amputee.
在糖尿病的并发症中，没有比足部坏疽和腿部截肢的威胁更具毁灭性的了。导致这种坏疽的血管功能不全、神经营养变化和感染的病理生理学已得到综述。基于这种病理生理学，概述了一种糖尿病足保守手术的方法。运用伤口愈合和软组织感染管理的已知原则，清除明显坏死或感染的组织，并对伤口进行保守处理。建议使用清创辅助手段，如脉动喷射冲洗、局部抗菌药物和生物敷料来控制感染，以便能用皮肤移植或局部皮瓣封闭伤口。这种方法可以挽救许多足部，并维持双下肢行走能力，因为糖尿病患者进行大截肢后的前景与非糖尿病截肢者明显不同。
