Wagner 3～4级糖尿病足保足治疗体会

Experience in the Foot Salvage Treatment of Diabetic Foot of Wagner Grade 3-4

目的探讨Wagner 3~4级糖尿病足的保足治疗体会。方法给予2015年5月—2017年5月韶关市第一人民医院烧伤外科收治的12例Wagner 3~4级糖尿病足患者在调节血糖、抗感染、改善微循环、营养神经等全身综合治疗的同时,局部于手术清除坏疽足趾及坏死组织后,创面应用湿润烧伤膏换药等方法予以保足治疗,观察治疗效果。结果 12例患者中除1例Wagner 4级糖尿病足患者因心力衰竭反复发作而死亡,1例Wagner 4级糖尿病足患者因合并尿毒症而截肢外,其余10例患者均保足成功,保足成功率为90.9%。结论以湿润烧伤膏换药治疗为基础,针对创面的不同情况选择负压封闭引流、自体微粒皮种植等方法联合治疗Wagner 3~4级糖尿病足,可有效促进糖尿病足溃疡创面的愈合,降低截肢率,疗效显著,值得临床推广应用。

Objective To discuss the experience in the foot salvage treatment for patients with diabetic foot of Wagner grade 3-4. Methods Twelve diabetic foot patients of Wagner Grade 3-4 who were admitted to the Burn Surgery Department of Shaoguan First People＇s Hospital from May 2015 to May 2017 were included into the study,to which systemic treatments such as blood glucose regulation,anti-infection,improvement of microcirculation and nutrient support were given,meanwhile the dressing change with MEBO was given to manage the wounds following the local surgical removal of gangrenous toes and necrotic tissues so as to save the foot as much as possible,and the therapeutic effect was observed.Results One patient with diabetic foot of Wagner grade 4 died due to recurrent heart failure,another one patient with diabetic foot of Wagner grade 4 underwent amputation due to uremia,and the rest 10 patients were treated well with their feet being preserved and the foot-preservation rate was 90. 9%. Conclusion Based on the dressing change with MEBO,selectively applying vacuum sealing drainage,micro-skin autograft or other therapies based on different wound conditions in treating diabetic foot of Wagner grade 3-4 can effectively promote the healing of diabetic foot ulcers and reduce amputation rate,deserving to be promoted in clinical practice.