PRS: Must diabetes foot must be amputated?Don’t forget to choose micro -surgical limbs!
Some micro -surgicals may hesitate to provide skin flap transplantation for diabetic limbs, because they are worried that extra, usually advanced diabetes complications increase the risk of lobe loss and final amputation. It is not uncommon to save the failure of diabetic limbs. Therefore, understanding the prevalence of complications in this patient group and the degree of increased skin flap failure and the risk of final amputation will better provide information for surgical plans. In addition, understanding the long -term results will lead to better risks and appropriate medical resources allocation.
This study is a retrospective study of the departure tissue transplantation from August 2011 to January 2018. Incident standards include whether to accept free organization transplantation, age over 18 years, and diagnosis of diabetes. Based on long -term results, patients are divided into successful babies or amputations. The research results were published in the PRS March issue, which reported the long -term results of micro -surgical limbs and the risk factors of re -amputation, and summarized and compared the previous relevant research results in the article.
Specific flap areas and types that are determined by supply factors, wound positions, flap function and aesthetic preferences. Due to the usually existence of calcified plaques in the choice of diabetic limbs, special considerations are needed in free tissue transplantation surgery. If the inflow of near -end skin flaps is affected by severe calcification and hardening, the researchers recommend that the non -invasive “from the inside to the outside” technology of the double -ended tainer microneedic needle. In this case, the calcified blood vessels should be treated with minimal power to limit the endometrial rupture of the calcified plaques; and if the receptor and the supply of blood vessels have been calcified, the large hidden vein supplement can be “end -to -end” land. Insert between related blood vessels. In order to avoid the risk of calcifying endometrial rupture and vascular thrombosis, it can be sutured from the inside to the outside. These methods minimize the problem of second membrane petals that are severely calcified and solve the problem of incompatible size. If calcification also damages the deep vein, it can also flow out of the inserted vein supplement to the shallow vein system.
All patients in the study adopt the same postoperative plan. The scheme is as follows: The skin petal inspection is performed 5 days before, and the seventh day starts the hanging inspection, and the bandaging is pressed within 7 to 6 months. All patients maintain a non -negative state within 4 weeks after surgery. Starting from wearing a walking boots, it has a gradual load and physical therapy. When needed, there will be custom -related shoes for orthopedics. In order to ensure that the shoes do not cause any recurrence, the researchers require patients to review frequently and conduct self -monitoring of patients.
A total of 64 patients met the standards. The total success rate of the instant leather petal transplantation is 94%. In the long run, 50 patients (78.1%) successfully preserved their limbs, and 14 patients (21.9%) needed to amputate. Four cases need to be amputated due to the loss of acute skin flaps, and 10 cases need to be amputated due to delay complications (hematoma, infections, and recurrence). The average coach time is 5.6 months. The risk factors of amputation are end -stage renal disease (OR30.7; P = 0.0087), posterior foot trauma (or4.6p = 0.020), hemoglobin A1C levels increased by more than 8.4%(OR1.4P = 0.020), and wound infection (OR6. 1P = 0.003).
The baseline hemoglobin A1C and platelet levels of patients with amputation are significantly higher than those of patients with limbs, but the smooth rate of vascularity of lower limbs is not significantly different.
4 of the 64 patients (6%) had surgical damage. These patients all needed amputated patients: 2/4 (50%) within 2 weeks after acute skin damage, 1/4 (25%25%(25%) ) When the 5 -month follow -up, the reason was the infection and gangrene infection and gangrene, and 1/4 (25%) occurred in the 7 -month follow -up because the transplant area waschemia. 4 of the 64 patients (6%) of hematoma appeared. No other complications occurred during the operation. Long -term complications include cracking and complications of supply areas; the latter two only affect patients with limbs.
Both patients eventually accepted the amputation of the thighs. After the first reconstruction, they needed a second free skin flap, which was 275 days and 875 days.
70%of the latest follow -up can be reopened. The overall limb retention rate of this sub -group was 78%, and in general, 84.4%achieved walking. 80%of the main amputated patients can walk. In contrast, this proportion of patients with limb security is 85.7%(P = 0.64). Among those who have the ability to move, 58%can be completed independently, and 42%of patients need help. Compared with amputated patients, patients with babies are more likely to walk independently. Can not walk on amputated patients and patients with successful abnormalities.
This is the first micro -surgical study that is committed to investigating the risk factors of adverse long -term results after receiving the transplantation and reconstruction of diabetic patients. Wandering tissue transplantation requires a wide range of perioperative resource allocation. In this era of efficiency and medical reform, the precursor of understanding of bad results can strengthen the team’s efforts and layers of babies candidates to obtain the ideal results. The total success rate and limb reservation rate of skin petlays are 94%and 78%, respectively. Of the 14 amputation patients, 4 cases were amputated due to damage to the skin, and 2 of them occurred in early postoperative. Among the 10 patients with a successful microvascular reconstruction, 8 cases were recurrent osteomyelitis, 1 case was infected with far -end wounds, and 1 case was hematoma. The risk factors of amputation include end -stage nephropathy, posterior foot trauma, hemoglobin A1C levels, and wound planting.
The management of chronic diseases should include a multi -disciplinary nursing team that focuses on optimizing medical care before surgery to stabilize microvascular conditions. Based on this, the team is currently conducting higher -power surveys to confirm their results. Due to severe internal medicine complications, such as end -stage nephropathy, it has not yet been classified as a clear contraindication of micro -surgical lower limb surgery. Researchers will continue to consider limb barantine surgery based on free tissue transplants. However, it must be noted that some patients will choose to accelerate the wound healing and recovery function through an amputation instead of the reconstruction of ionizing flap (that is, candidates for bad surgery and stubborn infection, end -stage renal diseases or attempts to try blood Patients with insufficient blood flow after transportation). For patients with high risk of surgery, the risk of long -term anesthesia may be greater than the effect of rescue. Despite the trial of blood transportation, patients with limited blood flow infusion should also consider an amputation. The non -remote infusion of the basic risks of planting and osteomyelitis after refractory debridement and osteomychilia is limited, which limits the success of long -term skin flaps.
The limitations of the study lies in the small retrospective design and the sample volume. In addition, surveys such as this study inevitably have a certain degree of choice, because the treatment of diabetes foot is very complicated, and there are many obstacles to the indication.
Considering the importance of surgeon’s experience and technical proficiency in obtaining good flap effects, how to achieve a good postoperative effect in a certain study is also a challenge to different doctors.
More and more positive results of the research feedback of micro -surgery in diabetic foot micro -surgery have greatly alleviated the concerns of the failed to open the micro -opening opening in diabetic people. Therefore, the ability to achieve the final closing of the wound while retaining the bilateral function makes the micro -surgical rescue the ideal choice for the damaged limbs of diabetic patients.
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However, since so far, the clear treatment of these patients is mainly limited to amputation of vascular or orthopedic surgery, and micro -surgical treatment has not yet become a conventional wound care method. In addition, early treatment is usually driven by drugs and internal secretions, and subsequent surgical therapy depends to a large extent depending on the referral mode and doctors. Therefore, the researchers believe that it is important that micro -surgeons should spread the benefits of conventional referrals to their colleagues early during the nursing process. In the case of promoting multi -disciplinary diabetic limbs, researchers are optimistic that on the basis of the crowd, it can significantly improve an amputation -free survival rate.
Multiple diabetes and poor blood glucose control are the risk factors of amputation after the limb surgery of ionized dermal flap limbs, but still have the opportunity to successfully protect their limbs.
In plastic surgery, the situation of diabetic patients that have no healing wounds is through early installation of prosthetic limb and positive rehabilitation training, or the method of multi -step reconstruction or amputation. There have been controversy. Considering the financial, medical, and social impacts of these two ways of nursing, accurate risk stratification and patient selection are essential. Through reporting the first large -scale micro -surgical surgery series dedicated to amputation risk assessment, researchers hope to improve the decision -making period of perioperative surgery and optimize the quality of life of patients.
