Diagnosis and topical treatment of diabetic foot in patients with burns / 解放军医学杂志

ABSTRACT

Objective To explore the diagnosis and topical treatment of diabetic foot in patients with burns.Methods Sixty-five patients with burns complicated with diabetic foot were admitted from Jan.2002 to Dec.2006.Bacterial culture of wound excretion,peripheral nerve electromyography and vascular ultrasonography of both lower extremities were performed in a part of patients.Twenty-four patients received topical treatment,including immersion bath with hypertonic saline solution and the application of epidermal growth factor,fibroblast growth factor and complex lysozyme disinfectant.Forty-one patients underwent surgical treatment.The operation methods,surgical treatment included debridement followed by direct closure,split-thickness skin grafting,repair with local skin flap or cross leg skin flap,or amputation of foot,as determined according to the condition of the wound.Results The positive rate of bacterial culture of wound excretion was 88.7%(47/53)on admission and 30.2%(16/53)one week after topical treatment.There were abnormal findings of peripheral nerve electromyography in all 31 cases.Vascular ultrasonography revealed pathological findings in both lower extremities of all 12 patients with vascular lesion,and 9 in 16 cases without vascular lesion.The lesions in all patients except 2,who were discharged in advance,healed and the cure rate was 96.9%.Conclusion Peripheral nerve electromyography and vascular ultrasonography of both lower extremities are promising auxiliary examinations for the diagnosis of diabetic foot in patients with burns.Topical treatment,which includes immersion bath with hypertonic saline solution and the application of growth factors and complex lysozyme disinfectant,as well as appropriate surgical management,plays an important role in the wound healing.