Gibbons G W
J Vasc Surg. 1987 May;5(5):791-3. doi: 10.1067/mva.1987.avs0050791.
Neuropathy, peripheral ischemia, and an altered host defense make the diabetic patient particularly prone to the development of infected foot ulcers. Successful treatment must be directed at these three primary pathologic situations. Since a limb-threatening infection carries a 25% risk of major amputation, early and prompt recognition and reporting of all foot problems are essential. Neuropathy requires total rest of the injured part. An altered host defense requires knowledge of the bacteria involved and proper use of antibiotics. It requires strict adherence to sound surgical principles that ensure debridement of all necrotic material and adequate dependent drainage of the wound while conserving as much viable skin and tissue for later revision or conservative amputations. Once sepsis is controlled, ischemic extremities can be revascularized. Because of the peculiar nature of the diabetic's vascular disease, revascularization procedures require the maximum skill and experience of the operating vascular surgeon. After revascularization, revisions or more conservative distal amputations can be achieved. Patient and physician education and understanding still remain essential not only to prevention but to successful management of all diabetic foot-related problems.
神经病变、外周缺血以及宿主防御功能改变，使得糖尿病患者特别容易发生足部感染性溃疡。成功的治疗必须针对这三种主要病理情况。由于威胁肢体的感染导致大截肢的风险为25%，因此早期及时识别并报告所有足部问题至关重要。神经病变需要受伤部位完全休息。宿主防御功能改变需要了解所涉及的细菌并正确使用抗生素。这需要严格遵循合理的外科原则，确保清除所有坏死物质，并使伤口有足够的低位引流，同时保留尽可能多的存活皮肤和组织以便后期修复或进行保守性截肢。一旦败血症得到控制，缺血肢体即可进行血管重建。由于糖尿病血管疾病的特殊性质，血管重建手术需要血管外科医生具备最高的技能和经验。血管重建后，可进行修复或更保守的远端截肢。患者和医生的教育及理解不仅对于预防，而且对于所有糖尿病足部相关问题的成功管理仍然至关重要。
