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Management of Diabetic Foot Ulcer

당뇨병성 족부 궤양의 치료

  • Seo, Dong-Kyo (Department of Orthopaedic Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Lee, Ho Seong (Department of Orthopaedic Surgery, Asan Medical Center, Ulsan University College of Medicine)
  • 서동교 (울산대학교 의과대학 서울아산병원 정형외과학교실) ;
  • 이호승 (울산대학교 의과대학 서울아산병원 정형외과학교실)
  • Received : 2014.01.23
  • Accepted : 2014.02.03
  • Published : 2014.03.15

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.

Keywords

References

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