Surgical Treatment of Diabetic Feet_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Jian , ZHAO Jun , MEI Jiacai , SHAO Mingzhe.

Department of Vascular Surgery, The Sixth People’s Hospital of Shanghai, Affiliated to Shanghai Jiaotong University, Shanghai 200233, China;

Corresponding author：

Keywords：

Diabetic foot; Ulcer; Diabetes; Peripheral arterial diseases; Lower limb; Treatment

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Abstract Full text Figures/Tables Video References Cited by

Objective To analyze the methods of treating diabetic feet and to evaluate the optimal method.
Methods The clinical data of 115 patients (137 legs) with diabetic feet were retrospectively analyzed.
Results Seventy-one affected legs were treated with balloon dilation or stenting (11 with additional debridement of local ulcer), 12 legs were treated by femoral-popliteal arterial bypass (5 with additional debridement of local ulcer), and 31 legs were treated by debridement of local ulcer or amputation merely, and another 23 legs were treated by medical therapy. All diabetic feet treated by surgical treatment were improved obviously without death and severe complications, while 2 cases with medicine therapy died.
Conclusion Because of the complexion of the diabetic foot, it should be treated individually, and the key point is to deal with the vascular lesions.

Citation： ZHANG Jian,ZHAO Jun,MEI Jiacai,SHAO Mingzhe.. Surgical Treatment of Diabetic Feet. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(7): 664-667. doi: Copy

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2.	Norgren L, Hiatt WR, Dormandy JA, et al. InterSociety Consensus for the Management of Peripheral Arterial Disease (TASC Ⅱ) [J]. J Vasc Surg, 2007; 45 Suppl S: S5S67.
3.	Lipsky BA. Diabetic foot infections. Pathophysiology, diagnosis, and treatment [J]. Int J Dermatol, 1991; 30(8): 560562.
4.	Richard JL, Schuldiner S. Epidemiology of diabetic foot problems [J]. Rev Med Interne, 2008; 29 Suppl 2: S222S230.
5.	Nather A, Bee CS, Huak CY, et al. Epidemiology of diabetic foot problems and predictive factors for limb loss [J]. J Diabetes Complications, 2008; 22(2): 7782.
6.	刘仁贵, 赵继春. 糖尿病并发下肢血管病变的发病机理及治疗进展 [J]. 中国普外基础与临床杂志, 2006; 13(6): 676679.
7.	张宪生, 邹英华, 王维亮. 纤维蛋白原与糖尿病下肢动脉缺血性病变的关系 [J]. 中国普外基础与临床杂志, 2005; 12(4): 前插.
8.	谷涌泉, 张建, 汪忠镐. 糖尿病下肢缺血外科治疗方法的选择 [J]. 中国糖尿病杂志, 2007; 15(4): 193195.
9.	张健, 邵明哲, 梅家才, 等. 糖尿病足的血管外科治疗 [J]. 中国现代普通外科进展, 2009; 12(12): 10661069.
10.	Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic InterSociety Consensus; and Vascular Disease Foundation [J]. Circulation, 2006; 113(11): e463e654.
11.	Faglia E, Dalla Paola L, Clerici G, et al. Peripheral angioplasty as the firstchoice revascularization procedure in diabetic patients with critical limb ischemia: prospective study of 993 consecutive patients hospitalized and followed between 1999 and 2003 [J]. Eur J Vasc Endovasc Surg, 2005; 29(6): 620627.
12.	Jacqueminet S, HartemannHeurtier A, Izzillo R, et al. Percutaneous transluminal angioplasty in severe diabetic foot ischemia: outcomes and prognostic factors [J]. Diabetes Metab, 2005; 31(4 Pt 1): 370375.
13.	Alexandrescu VA, Hubermont G, Philips Y, et al. Selective primary angioplasty following an angiosome model of reperfusion in the treatment of Wagner 14 diabetic foot lesions: practice in a multidisciplinary diabetic limb service [J]. J Endovasc Ther, 2008; 15(5): 580593.
14.	Faglia E, Clerici G, Clerissi J, et al. Early and fiveyear amputation and survival rate of diabetic patients with critical limb ischemia: data of a cohort study of 564 patients [J]. Eur J Vasc Endovasc Surg, 2006; 32(5): 484490.
15.	Gerassimidis T, Karkos C, Karamanos D, et al. Current endovascular management of the ischaemic diabetic foot [J]. Hippokratia, 2008; 12(2): 6773.
16.	Lantis J, Jensen M, Benvenisty A, et al. Outcomes of combined superficial femoral endovascular revascularization and popliteal to distal bypass for patients with tissue loss [J]. Ann Vasc Surg, 2008; 22(3): 366371.
17.	Ferraresi R, Centola M, Ferlini M, et al. Longterm outcomes after angioplasty of isolated, belowtheknee arteries in diabetic patients with critical limb ischaemia [J]. Eur J Vasc Endovasc Surg, 2009; 37(3): 336342.
18.	韩冰, 王家祥, 王兵. 血管腔内修复术治疗糖尿病性下肢动脉硬化闭塞症 [J]. 医学研究与教育, 2009; 26(6): 2224, 45.
19.	Ihnat DM, Duong ST, Taylor ZC, et al. Contemporary outcomes after superficial femoral artery angioplasty and stenting: the influence of TASC classification and runoff score [J]. J Vasc Surg, 2008; 47(5): 967974.
20.	Cull DL, Langan EM, Gray BH, et al. Open versus endovascular intervention for critical limb ischemia: a populationbased study [J]. J Am Coll Surg, 2010; 210(5): 555561, 561553.
21.	Baril DT, Chaer RA, Rhee RY, et al. Endovascular interventions for TASC Ⅱ D femoropopliteal lesions [J]. J Vasc Surg, 2010; 51(6): 14061412.
22.	Baril DT, Marone LK, Kim J, et al. Outcomes of endovascular interventions for TASC Ⅱ B and C femoropopliteal lesions [J]. J Vasc Surg, 2008; 48(3): 627633.
23.	Setacci C, Chisci E, de Donato G, et al. Subintimal angioplasty with the aid of a reentry device for TASC C and D lesions of the SFA [J]. Eur J Vasc Endovasc Surg, 2009; 38(1): 7687.
24.	郭相江, 张纪蔚. 糖尿病下肢动脉硬化闭塞症的腔内治疗进展 [J]. 上海医学, 2009; 32(5): 455458.

1. Schaper NC, Apelqvist J, Bakker K. The international consensus and practical guidelines on the management and prevention of the diabetic foot [J]. Curr Diab Rep, 2003; 3(6): 475479.
2. Norgren L, Hiatt WR, Dormandy JA, et al. InterSociety Consensus for the Management of Peripheral Arterial Disease (TASC Ⅱ) [J]. J Vasc Surg, 2007; 45 Suppl S: S5S67.
3. Lipsky BA. Diabetic foot infections. Pathophysiology, diagnosis, and treatment [J]. Int J Dermatol, 1991; 30(8): 560562.
4. Richard JL, Schuldiner S. Epidemiology of diabetic foot problems [J]. Rev Med Interne, 2008; 29 Suppl 2: S222S230.
5. Nather A, Bee CS, Huak CY, et al. Epidemiology of diabetic foot problems and predictive factors for limb loss [J]. J Diabetes Complications, 2008; 22(2): 7782.
6. 刘仁贵, 赵继春. 糖尿病并发下肢血管病变的发病机理及治疗进展 [J]. 中国普外基础与临床杂志, 2006; 13(6): 676679.
7. 张宪生, 邹英华, 王维亮. 纤维蛋白原与糖尿病下肢动脉缺血性病变的关系 [J]. 中国普外基础与临床杂志, 2005; 12(4): 前插.
8. 谷涌泉, 张建, 汪忠镐. 糖尿病下肢缺血外科治疗方法的选择 [J]. 中国糖尿病杂志, 2007; 15(4): 193195.
9. 张健, 邵明哲, 梅家才, 等. 糖尿病足的血管外科治疗 [J]. 中国现代普通外科进展, 2009; 12(12): 10661069.
10. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic InterSociety Consensus; and Vascular Disease Foundation [J]. Circulation, 2006; 113(11): e463e654.
11. Faglia E, Dalla Paola L, Clerici G, et al. Peripheral angioplasty as the firstchoice revascularization procedure in diabetic patients with critical limb ischemia: prospective study of 993 consecutive patients hospitalized and followed between 1999 and 2003 [J]. Eur J Vasc Endovasc Surg, 2005; 29(6): 620627.
12. Jacqueminet S, HartemannHeurtier A, Izzillo R, et al. Percutaneous transluminal angioplasty in severe diabetic foot ischemia: outcomes and prognostic factors [J]. Diabetes Metab, 2005; 31(4 Pt 1): 370375.
13. Alexandrescu VA, Hubermont G, Philips Y, et al. Selective primary angioplasty following an angiosome model of reperfusion in the treatment of Wagner 14 diabetic foot lesions: practice in a multidisciplinary diabetic limb service [J]. J Endovasc Ther, 2008; 15(5): 580593.
14. Faglia E, Clerici G, Clerissi J, et al. Early and fiveyear amputation and survival rate of diabetic patients with critical limb ischemia: data of a cohort study of 564 patients [J]. Eur J Vasc Endovasc Surg, 2006; 32(5): 484490.
15. Gerassimidis T, Karkos C, Karamanos D, et al. Current endovascular management of the ischaemic diabetic foot [J]. Hippokratia, 2008; 12(2): 6773.
16. Lantis J, Jensen M, Benvenisty A, et al. Outcomes of combined superficial femoral endovascular revascularization and popliteal to distal bypass for patients with tissue loss [J]. Ann Vasc Surg, 2008; 22(3): 366371.
17. Ferraresi R, Centola M, Ferlini M, et al. Longterm outcomes after angioplasty of isolated, belowtheknee arteries in diabetic patients with critical limb ischaemia [J]. Eur J Vasc Endovasc Surg, 2009; 37(3): 336342.
18. 韩冰, 王家祥, 王兵. 血管腔内修复术治疗糖尿病性下肢动脉硬化闭塞症 [J]. 医学研究与教育, 2009; 26(6): 2224, 45.
19. Ihnat DM, Duong ST, Taylor ZC, et al. Contemporary outcomes after superficial femoral artery angioplasty and stenting: the influence of TASC classification and runoff score [J]. J Vasc Surg, 2008; 47(5): 967974.
20. Cull DL, Langan EM, Gray BH, et al. Open versus endovascular intervention for critical limb ischemia: a populationbased study [J]. J Am Coll Surg, 2010; 210(5): 555561, 561553.
21. Baril DT, Chaer RA, Rhee RY, et al. Endovascular interventions for TASC Ⅱ D femoropopliteal lesions [J]. J Vasc Surg, 2010; 51(6): 14061412.
22. Baril DT, Marone LK, Kim J, et al. Outcomes of endovascular interventions for TASC Ⅱ B and C femoropopliteal lesions [J]. J Vasc Surg, 2008; 48(3): 627633.
23. Setacci C, Chisci E, de Donato G, et al. Subintimal angioplasty with the aid of a reentry device for TASC C and D lesions of the SFA [J]. Eur J Vasc Endovasc Surg, 2009; 38(1): 7687.
24. 郭相江, 张纪蔚. 糖尿病下肢动脉硬化闭塞症的腔内治疗进展 [J]. 上海医学, 2009; 32(5): 455458.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Surgical Treatment of Diabetic Feet

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