糖尿病足溃疡患者的外科截肢：中国专家小组共识治疗指南
Surgical amputation for patients with diabetic foot ulcers: A Chinese expert panel consensus treatment guide.
作者信息
Liao Xuan, Li Sheng-Hong, El Akkawi Mariya Mohamad, Fu Xiao-Bing, Liu Hong-Wei, Huang Yue-Sheng
机构信息
Department of Plastic Surgery of the First Affiliated Hospital of Jinan University, Institute of New Technology of Plastic Surgery of Jinan University, Key Laboratory of Regenerative Medicine of Ministry of Education, Guangzhou, China.
Wound Healing and Cell Biology Laboratory, Institute for Basic Research, Trauma Center of Postgraduate Medical College, General Hospital of PLA, Beijing, China.
出版信息
Front Surg. 2022 Nov 8;9:1003339. doi: 10.3389/fsurg.2022.1003339. eCollection 2022.
BACKGROUND
Diabetic foot disease is a serious complication of diabetes mellitus. Patients with diabetes mellitus have a 25% lifetime risk for developing a foot ulcer, and between 14% and 24% of patients require a major or minor lower limb amputation due to severe gangrene. However, decisions concerning whether to amputate or whether to perform a major or minor lower limb amputation, and how best to determine the amputation plane remain unclear.
METHODS
To consolidate the current literature with expert opinion to make recommendations that will guide surgical amputation for patients with diabetic foot ulcers. A total of 23 experts experienced in surgical treatment of patients with diabetic foot ulcers formed an expert consensus panel, and presented the relevant evidence, discussed clinical experiences, and derived consensus statements on surgical amputation for patients with diabetic foot ulcers. Each statement was discussed and revised until a unanimous consensus was achieved.
RESULTS
A total of 16 recommendations for surgical amputation for patients with diabetic foot ulcers were formulated. The experts believe that determination of the amputation plane should be comprehensively evaluated according to a patient's general health status, the degree of injury, and the severity of lower limb vasculopathy. The Wagner grading system and the severity of diabetic lower extremity artery disease are important criteria when determining the degree of amputation. The severity of both diabetic foot infection and systemic underlying diseases are important factors when considering appropriate treatment. Moreover, consideration should also be given to a patient's socioeconomic status. Given the complexities of treating the diabetic foot, relevant issues in which consensus could not be reached will be discussed and revised in future.
CONCLUSION
This expert consensus could be used to guide doctors in clinical practice, and help patients with diabetic foot ulcers gain access to appropriate amputation treatment.
背景
糖尿病足病是糖尿病的一种严重并发症。糖尿病患者一生中发生足部溃疡的风险为25%，14%至24%的患者因严重坏疽需要进行大或小的下肢截肢。然而，关于是否截肢、进行大或小的下肢截肢以及如何最好地确定截肢平面的决策仍不明确。
方法
整合当前文献并结合专家意见，提出指导糖尿病足溃疡患者手术截肢的建议。共有23名在糖尿病足溃疡患者手术治疗方面经验丰富的专家组成了专家共识小组，他们展示了相关证据，讨论了临床经验，并得出了关于糖尿病足溃疡患者手术截肢的共识声明。每个声明都经过讨论和修订，直至达成一致共识。
结果
共制定了16条关于糖尿病足溃疡患者手术截肢的建议。专家们认为，截肢平面的确定应根据患者的一般健康状况、损伤程度和下肢血管病变的严重程度进行综合评估。在确定截肢程度时，Wagner分级系统和糖尿病下肢动脉疾病的严重程度是重要标准。在考虑适当治疗时，糖尿病足感染的严重程度和全身性基础疾病都是重要因素。此外，还应考虑患者的社会经济状况。鉴于糖尿病足治疗的复杂性，未来将对未能达成共识的相关问题进行讨论和修订。
结论
本专家共识可用于指导医生的临床实践，并帮助糖尿病足溃疡患者获得适当的截肢治疗。
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