[Surgical strategy in treatment of diabetic foot].
OBJECTIVE
To investigate the surgical strategy of diabetic foot (DF) and analyze the therapeutic efficacy.


METHODS
From July 2004 to July 2007, 36 patients (22 males and 14 females) with DF were treated, with an average age of 57 years(43-82 years). The disease course of diabetes was 3 months to 27 years (12 years on average) and the disease course of DF was 1 month to 2 years (7 months on average). According to Wagner classification of DF, there were 3 cases of grade 1, 12 cases of grade 2, 10 cases of grade 3, 7 cases of grade 4 and 4 cases of grade 5. The locations of ulcer were ankle and heel in 9 cases, medial part of foot in 14 cases, in lateral part of foot in 8 cases and sinus formation in 5 cases. The ulcer sizes ranged from 4 cm x 2 cm-18 cm x 9 cm. Initial management of these patients included control of blood sugar level, proper hydration, administration of antibiotics, treatment of coexisting diseases, and repeated debridements of wounds when necessary. Ulcers were treated with debridement and split skin transplantation in 3 cases of grade 1, with debridement and drainage of abscesses and split skin transplantation in 12 of grade 2, with debridement and transplantation of flap in 17 of grade 3 and grade 4, and with transplantation of fascial flap in 5 cases of sinus; ulcers were treated firstly with artery bypass of lower extremity, and then treated with local amputation of foot to avoid high-level amputation and to save more function of foot in 4 of grade 5.


RESULTS
In 36 cases, wound in 31 cases (86.1%) cured primarily, wound did not heal in 1 patient (2.1%) and received re-amputation, there were 2 deaths because of infection with multiple organ failure postoperatively. Twenty-nine cases were followed up 8 months (range, 6 -15 months). Eight patients developed new ulcers, with 3 lesions in situ and 5 lesions in new site.


CONCLUSIONS
Surgical regimen could play an important role in treatment of diabetic foot. According to different grades of DF, there were different strategies in dealing with the accompanied inflammation and ulcer. An active and comprehensive surgical treatment of DF could save the foot, avoid the high-level amputation and result in more functional extremity.
Cen
Shiqiang
S
Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, PR China.
Huang
Fuguo
F
Zhao
Jichun
J
Lu
Wusheng
W
Wang
Chun
C
Ran
Xingwu
X
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017719:Diabetic Foot / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D016523:Foot Ulcer / Q000601:surgery; D005734:Gangrene / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D014945:Wound Healing