당뇨병성 족부 궤양의 치료 = Management of Diabetic Foot Ulcer

다국어 초록 (Multilingual Abstract)

In patients with diabetic foot, ulceration and amputation are the most serious consequences and can lead to morbidity and disability. Peripheral arterial sclerosis, peripheral neuropathy, and foot deformities are major causes of foot problems. Foot deformities, following autonomic and motor neuropathy, lead to development of over-pressured focal lesions causing the diabetic foot to be easily injured within the shoe while walking. Wound healing in these patients can be difficult due to impaired phagocytic activity, malnutrition, and ischemia. Correction of deformity or shoe modification to relieve the pressure of over-pressured points is necessary for ulcer management. Application of selective dressings that allow a moist environment following complete debridement of the necrotic tissue is mandatory. In the case of a large soft tissue defect, performance of a wound coverage procedure by either a distant flap operation or a skin graft is necessary. Patients with a Charcot joint should be stabilized and consolidated into a plantigrade foot. The bony prominence of a Charcot foot can be corrected by a bumpectomy in order to prevent ulceration. The most effective management of the diabetic foot is ulcer prevention: controlling blood sugar levels and neuropathic pain, smoking cessation, stretching exercises, frequent examination of the foot, and appropriate education regarding footwear.

참고문헌 (Reference)

1 Mendonca DA, "Vacuum-assisted closure to aid wound healing in foot and ankle surgery" 26 : 761-766, 2005

2 Keast DH, "Use of the charcot restraint orthotic walker in treatment of neuropathic foot ulcers : a case series" 26 : 549-552, 2013

3 Pinzur MS, "Treatment of Eichenholtz stage I Charcot foot arthropathy with a weightbearing total contact cast" 27 : 324-329, 2006

4 Mann RA, "Tibial sesamoid shaving for treatment of intractable plantar keratosis" 13 : 196-198, 1992

5 Ku BJ, "The clinical observations in diabetic patients with foot ulcer" 3 : 244-252, 2002

6 김대중, "The Epidemiology of Diabetes in Korea" 대한당뇨병학회 35 (35): 303-308, 2011

7 Coughlin MJ, "Surgery of the foot and ankle" Mosby 2007

8 Assal M, "Realignment and extended fusion with use of a medial column screw for midfoot deformities secondary to diabetic neuropathy. Surgical technique" 92 (92): 20-31, 2010

9 Apelqvist J, "Prognostic value of systolic ankle and toe blood pressure levels in outcome of diabetic foot ulcer" 12 : 373-378, 1989

10 Lin SS, "Plantar forefoot ulceration with equinus deformity of the ankle in diabetic patients: the effect of tendo-Achilles lengthening and total contact casting" 19 : 465-475, 1996

11 Ertugrul BM, "Osteomyelitis or Charcot neuro- osteoarthropathy? Differentiating these disorders in diabetic patients with a foot problem" 4 : 2013

12 Bamberger DM, "Osteomyelitis in the feet of diabetic patients. Long-term results, prognostic factors, and the role of antimicrobial and surgical therapy" 83 : 653-660, 1987

13 Madhok BM, "New techniques for wound debridement" 10 : 247-251, 2013

14 Berendt AR, "Is this bone infected or not? Differentiating neuro-osteoarthropathy from osteomyelitis in the diabetic foot" 4 : 424-429, 2004

15 Prosdocimi M, "Impaired wound healing in diabetes : the rationale for clinical use of hyaluronic acid plus silver sulfadiazine" 103 : 533-539, 2012

16 Valenzuela-Silva CM, "Granulation response and partial wound closure predict healing in clinical trials on advanced diabetes foot ulcers treated with recombinant human epidermal growth factor" 36 : 210-215, 2013

17 Richmond NA, "Evidence-based management of common chronic lower extremity ulcers" 26 : 187-196, 2013

18 Cullen BD, "Early results with use of the midfoot fusion bolt in Charcot arthropathy" 52 : 235-238, 2013

19 Malhotra S, "Diabetic foot ulcerations : biomechanics, charcot foot, and total contact cast" 25 : 66-69, 2012

20 Oh TS, "Diabetic foot reconstruction using free flaps increases 5-year-survival rate" 66 : 243-250, 2013

21 Wheat LJ, "Diabetic foot infections. Bacteriologic analysis" 146 : 1935-1940, 1986

22 Kim KW, "Diabetic Foot" 50 : 447-454, 2007

23 Beckman JA, "Diabetes and atherosclerosis : epidemiology, pathophysiology, and management" 287 : 2570-2581, 2002

24 Malone M, "Deep wound cultures correlate well with bone biopsy culture in diabetic foot osteomyelitis" 29 : 546-550, 2013

25 Donas KP, "Below knee bare nitinol stent placement in highrisk patients with critical limb ischemia is still durable after 24 months of follow-up" 52 : 356-361, 2010

26 Grant WP, "Beaming the columns for Charcot diabetic foot reconstruction : a retrospective analysis" 50 : 182-189, 2011

27 Kim JM, "A clinical study on the diabetic foot lesions" 17 : 387-394, 1993

28 Wagner FW, "A classification and treatment program for diabetics, neuropathic and dysvascular foot problems" 28 : 143-144, 1979

29 Kwon YJ, "A Clinical study on the diabetic foot lesions" 13 : 39-46, 1989