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Open Foot/Toe Amputation and Hydrocolloid Dressing as Wound Management in Patients with Infected PAOD and Diabetic Foot - Long-term Follow-up

開放性足/趾截肢術和水合性敷料作為周邊血管阻塞併糖尿病足 感染性傷口的一種治療方式及其長期追蹤

Abstracts


Background: Diabetic patients with peripheral arterial occlusion disease (PAOD) often suffer from other systemic diseases and are prone to severe wound infection. All patients prefer less and shorter surgical amputation and wish to preserve their toes and feet as long as possible. On the other hand, the traditional closed toe and foot amputations tend to shorten the toes and feet which may hardly be acceptable to diabetic patients with PAOD, both physical and psychological. Aim and Objectives: Our aim is to propose an option of wound management in patients with PAOD and diabetic foot to control infection, reduce the frequency of operation and anesthesia, and finally preserve the foot length and keep the ankle function. Materials and Methods: A total of 61 consecutive patients, aged 43-89 years, with infected PAOD and diabetic foot were studied; all patients underwent vascular bypass surgery and different levels of open foot/toe amputation depending on the severity of infection followed by modern dressings. Those who followed up for 3 years were reported. Results: Almost all patients who underwent open foot/toe amputation with hydrocolloid dressing experienced complete wound healing with or without skin grafting in 6 months. The time from definite amputation to ready to skin graft was approximately 3 weeks, and the mean time to complete wound healing without skin graft was 2 months. Conclusion: Open foot/toe amputation and hydrocolloid dressings was proved to be an effective alternative to control infection, improve wound healing, reduce the frequency of anesthesia and potential operation, and finally may preserve the foot length and keep the ankle function.

Parallel abstracts


背景:患有周邊血管阻塞的糖尿病足的病人常合併其他全身性疾病。稍有不慎,容易有傷口並造成嚴重感染。病人都希望盡可能減少手術次數及複雜度並保持足/趾的長度。傳統上的截肢手術,為了立刻將傷口縫合勢必縮短足/趾的長度,不管是心理上或生理上,對病人言都難以接受。目的及目標:我們的目標是盡量利用簡短的手術,控制傷口感染,促進傷口癒合並盡量保有病人足/趾的長度。材料及方法:我們蒐集61位同時患有周邊血管阻塞及糖尿病足的病人,病人年齡從43歲到89歲,都接受過動脈血管繞道手術,視感染情況接受不同程度的開放性足/趾截肢手術和水合性敷料的治療,追蹤超過3年。結果:接受開放性足/趾截肢手術和水合性人工敷料治療的病人,他們的傷口都在6個月內癒合。有接受植皮手術的病人,傷口大約在術後3個星期癒合。無植皮者,傷口平均約2個月完全癒合。總論:開放性足/趾截肢術和現代的人工敷料,可作為周邊血管阻塞併糖尿病足感染性傷口患者另一種有效的治療方式:容易控制感染,促進傷口癒合,減少麻醉及手術次數,及保有足部的長度及腳踝的功能。

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