The annual incidence of diabetic foot ulcers in China is as high as 8.1%, which ranks first among the causes of chronic wounds in China. Although through the efforts of several generations of podiatrists and the building of multidisciplinary collaboration team, the major amputation rate in patients with diabetic foot ulcers in China has been decreased significantly, it is still far higher than the level of developed countries in Europe and the United States. Therefore, in order to cope with the increasing occurrence and recurrence of refractory diabetic foot ulcers, in addition to further optimizing the construction of multidisciplinary collaboration team, it is an urgent topic for us to explore the construction of a multidisciplinary integrated team to seamlessly connect the diagnosis and treatment of different aspects of foot disease. This article describes the importance and necessity of building a wound repair center with Chinese characteristics, which is a model of multidisciplinary integrated team, aiming at provide a theoretical basis for establishing a multidisciplinary integrated management model and realizing seamless connection between diagnosis and treatment, so as to further improve the cure rate of diabetic foot ulcers.
目的：对糖尿病足溃疡中面积和体积计算的方法学的临床应用进行评价。方法：广泛查阅文献,并结合我们的实际，对计算糖尿病足溃疡中面积和体积的各种方法效果进行综合分析。结果：目前常用于计算糖尿病足溃疡面积的方法有公式法、数码照像计算法、无菌薄膜勾边法等，但以数码照像计算法更准确，更易被患者接受；目前常用于计算糖尿病足溃疡体积的方法有公式法、媒介填充法、CT足部扫描法等，但以媒介填充法更经济易行。结论：数码照像计算法是目前较好的用于测量糖尿病足溃疡面积的方法，而媒介填充法是较简便易行的测量糖尿病足溃疡体积的方法。
The Diabetic Foot and Peripheral Vascular Disease Study Group, Chinese Diabetes Society, released an expert advice Recommendations of Chinese Experts on the Standardized Diagnosis and Treatment of Diabetic Foot During Coronavirus Disease (COVID-19) Pandemic, and the International Diabetic Foot Care Group and D-Foot International released a document Fast-track Pathway for Diabetic Foot Ulceration During COVID-19 Crisis: A Document from International Diabetic Foot Care Group and D-Foot International during the 2020 outbreak, respectively. Both have the same goals, but the implementation focuses are different. The aim of this article is to give an interpretation of both expert advices in terms of the general principles, the epidemic prevention and control, the family, community and hospitalization management model of diabetic foot, the holistic principle of diabetic foot standardized management, and the telemedicine application in the late epidemic period.
Objective To review and evaluate the clinical application of autologous plateletrich gel (APG) in refractory chronic diabetic cutaneous ulcers. Methods The latest literature was extensively reviewed, and the potential mechanism of APG for healing diabetic cutaneous ulcers was discussed. Results APG accelerated the ulcer healing, especially in healing the refractory diabetic cutaneous ulcers, and the high-level growth factors from the platelet releasate were thought to be the major potential mechanism of the APG action. Conclusion APG can promote the healing of refractory chronic diabetic cutaneous ulcers. Topical haemotherapy withAPG may be considered an adjuvant treatment of a multidisciplinary process and may be useful to the effective therapy of cutaneous ulcers.
Collagenase can promote wound healing, and its effect depends on the degradation of necrotic tissue and the collagen degradation products produced by collagenase. The possible mechanisms include accelerating re-epithelialization, promoting the formation of granulation tissue and blood vessels, and regulating inflammatory response. At present, clinical studies have shown that collagenase combined with sharp debridement or negative pressure wound therapy can significantly promote the healing of diabetic foot ulcers, and its efficacy is similar to that of hydrocolloid occlusive dressing and silver-containing wound dressings. Collagenase can promote the repair of diabetic foot ulcers, but its effect is affected by many factors, and large-sample, good design, high quality and multi-center randomized controlled trials are still needed to explore its efficacy and appropriate use conditions. This paper expounds that collagenase is one of the options in the treatment of diabetic foot ulcers from mechanism and clinical effect.
Objective To review the effect of dipeptidyl peptidase 4 (DPP-4) inhibitors on the wound healing and its mechanisms in chronic diabetic foot ulcers. Methods The latest literature concerning DPP-4 inhibitors for chronic diabetic foot ulcers was extensively reviewed, as well as the potential benefit and mechanism of DPP-4 inhibitors on wound healing of diabetic foot ulcers was analyzed thoroughly. Results DPP-4 inhibitors can accelerated the ulcer healing. The mechanisms probably include inhibiting the expression of the matrix metalloproteinase (MMP) and restoring the balance of the wound MMP and the tissue inhibitors of MMP; promoting recruitment of endothelial progenitor cells and augmenting angiogenesis; optimizing extracellular matrix construction and the immune response to persistent hypoxia in chronic diabetes wounds, and so on. At present, clinical researches show that DPP-4 inhibitors may be considered as an adjuvant treatment for chronic diabetic foot ulcers. Conclusion DPP-4 inhibitors show promise in the local wound healing of chronic diabetic foot ulcers. However, more strictly designed, adequately powered, long-term follow-up, and high-quality randomized control trials are needed to further verify their efficacy and safety for chronic diabetic foot ulcers.
Objective To review the mechanism of cold atmospheric plasma (CAP) in the treatment of chronic skin ulcer, providing a new idea for ulcer therapy. Methods The literature about CAP in the treatment of chronic skin ulcers in recent years was extensively screened and reviewed. The treatment principle, active ingredients, and mechanism were summarized. Results CAP is partial ionized gas discharged by plasma generator in high frequency under high voltage. It contains electrons, positive and negative ions, reactive oxygen species, reactive nitrogen species, and ultraviolet rays. In vitro and animal experiments show that the active ingredients contained in CAP can inactive microorganisms, against biofilm, regulate immune-mediated inflammatory, promoting blood flow, stimulate tissue regeneration and epithelial formation in the course of wounds healing. Conclusion CAP play a role in different stages of chronic skin ulcer healing, with good effectiveness and safety, and broad clinical application prospects. But more studies are needed to explore the indications and dosages of CAP therapy.