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Editor's note: This year is the year of medical business construction of Zhangjiajie People's Hospital, in order to further enhance the connotation of medical services, facilitate the masses to see a doctor, and promote the reform of urban and rural medical integration in Zhangjiajie City, since April, Zhangjiajie People's Hospital will unite with the red network Zhangjiajie Station and other media to carry out a series of reports focusing on discipline development, technological innovation, medical reform, and humanistic stories.
RedNet Moment News Reporter Zhang Hong reported
What is Diabetic Foot? What are its symptoms? And how should it be treated and prevented? Recently, the red network moment news reporter walked into Zhangjiajie People's Hospital, and Deng Wei, attending physician of the first ward of the orthopedic department of the hospital, gave a detailed introduction.
Diabetic foot (hereinafter referred to as sugar foot) refers to the destruction of the skin and deep tissues at the distal end of the ankle joint of diabetic patients, often co-infected and /or arterial occlusion of different degrees of lower limbs, and in severe cases, involves muscle and bone tissue, which is an important cause of disability and death in diabetic patients.
In order to meet the diagnosis and treatment needs of sugar foot patients in recent years, the first ward of the Department of Orthopedics of Zhangjiajie People's Hospital has sent personnel to Xiangya Hospital, Southwest Hospital and Nanhua Hospital to study sugar foot and slow trauma since 2019, and set up a chronic difficult wound diagnosis and treatment team in 2020, and now gradually formed six major surgical core technologies and five non-surgical core technologies for the treatment of sugar foot, during which the first case of periosteal stretching surgery and the first case of lateral tibia transverse transport surgery were completed in northwest Hunan Province. In the past three years, more than 200 cases of sugar foot patients (wager level 3 or above) have been diagnosed and treated, and more than 100 surgeries have been carried out, which has brought good news to the majority of sugar foot patients.
The "core technology of surgery" allows patients to spend a small amount of money to treat major diseases
Mr. Zhao, a type 2 diabetic patient in his 60s, has suffered from sugar foot for more than 1 year and has received treatment in many hospitals, but due to the epidemic situation, he changed his own medicine after discharge, his right heel festered and died again, the skin was swollen obviously, and there was a large amount of purulent foul-smelling liquid oozing out, which made him painful.
In order to seek further treatment, Mr. Zhao inquired and came to the Endocrinology Department of Zhangjiajie People's Hospital for treatment again. After consultation with the diabetic foot MDT team of the hospital, deng Wei, the attending physician of the first ward of orthopedics, led the team to fully discuss and formulate the surgical plan of "right heel expansion + infection lesion clearance + VSD coverage + lateral tibia". After the infection was controlled, the wound care team carefully changed the dressing. After more than 1 month of diagnosis and treatment, the wound on the sole of the patient's right foot has healed. From the sad face when he first came to the smile when he was discharged, Mr. Zhao's son was grateful: "Thanks to your careful treatment and intimate care, my father can recover quickly and well, and it is indeed right to come here!" ”
Due to the remarkable efficacy, many diabetic foot patients have also come to see the doctor. In June last year, the department received a woman named Zhang. The patient has a history of diabetes for 6 years, usually pays attention to life treatment, but because he participates in the village help work, neglects foot protection, after soaking in water near the little toe of the right foot, repeated ulceration, exudation for a month, the skin has obvious defects, bone exposure. Through the introduction of a friend, Ms. Zhang rushed to the first ward of the Orthopedic Department of Zhangjiajie People's Hospital to seek medical treatment. After receiving the treatment, Deng Wei led the slow-trauma team to carefully study the condition and decided to use the method of "foot debridement" in the first stage and "periosteal stretching" in the second stage to treat it. After two surgeries, the patient's toe was successfully saved, and he gave the medical staff a thumbs up from the heart.
Deng Wei told reporters that the department has core technologies such as "VSD + skin grafting technology", "artificial dermal technology", "antibiotic bone cement technology", "horizontal bone handling technology", "periosteal stretching technology" and "skin stretching technology", and adopts the "integrated" diagnosis and treatment mode to help sugar foot patients spend a small amount of money to treat major diseases.
In addition, in addition to the above six major surgical core technologies, the department also has non-surgical core technologies such as "closed negative pressure irrigation and drainage technology VSD", "characteristic debridement combined wet healing technology", "growth factor technology (PRP, CGF, external growth factor)", "hyperbaric oxygen therapy" and "infrared therapy" in addition to conventional dressing technology, which can be treated for different degrees and different stages of sugar foot wounds, with remarkable efficacy and widely praised by patients.
After the patient is admitted to the hospital, the medical staff will evaluate the patient's situation as a whole, formulate the optimal treatment strategy for the patient, and after clarifying that only non-surgical treatment can be taken, the characteristic wound debridement will be carried out in the hospital bed, and the "non-surgical core technology" will be adopted according to different wound conditions, so that the patient's wound can heal rapidly through precision treatment, so as to avoid the pain of amputation of the patient. The department of endocrinology, vascular surgery, and hand and foot surgery that make up the diabetic foot MDT team are even stronger backing, precise treatment of diseases, and the multidisciplinary cooperation mode of the whole hospital has treated hundreds of cases of patients in one year.
Patients recognize not only the superb level of diagnosis and treatment of the department, but also the conscientious and responsible attitude and meticulous service of medical staff. Zhang Jinhua, head nurse of the first ward of the Department of Orthopedics, said that the treatment cycle of sugar foot patients is long, bringing heavy economic burdens and psychological pressure to patients and families, and in the face of this special group, medical staff need to integrate the care and care for patients into every detail of their work.
In addition to daily treatment and nursing, medical staff will actively integrate into the patient group, so that patients can learn to self-regulate and defeat the disease with a positive and optimistic attitude. In order to provide patients with comprehensive and continuous care, the responsible nurses will conduct regular telephone follow-up visits to understand the patient's diet, medication, blood sugar control and other aspects after discharge and provide professional guidance.
Experts remind: Diabetic foot disease is expensive in early prevention and early treatment
Sugar foot is a serious foot complication of diabetes. According to statistics, the total amputation rate of patients with sugar foot ulcers is 19.03%, while the mortality rate after amputation is as high as 40%. Deng Wei reminded the general public that sugar foot prevention is far more important than treatment, once any foot problem is found, you must go to the hospital in time, do not have a fluke mentality.
Prevention Tip 1: Global Strategy
1. Know thyself and know the other. To defeat sugar foot, the first task is to correctly understand it. Encouraging sugar friends to regularly participate in health science popularization activities and master the knowledge of sugar foot can reduce the occurrence and recurrence of sugar foot ulcers.
2. Control blood sugar, blood pressure and blood lipids. Sugar friends are often very concerned about their blood sugar, in fact, blood pressure and blood lipids can not be ignored. Chronic hyperglycemia can lead to microvascular complications, hypertension can exacerbate peripheral arterial disease, and dyslipidemia can cause diabetic vascular disease. Blood sugar, blood pressure and lipids are like three brothers, and comprehensive management to achieve the ideal goal can effectively reduce the risk of sugary feet.
3. Quit smoking. Scientific studies have shown that smoking increases the risk of developing and recurring sugar foot ulcers. Harmful substances produced by smoking can inhibit the body's normal metabolism, while the nicotine contained in tobacco can cause vasoconstriction spasms, resulting in ischemia and hypoxia in the feet.
4. Moderate and regular exercise. Exercise can increase insulin sensitivity, help control blood sugar, lose weight, and improve circulation. It is recommended that sugar friends carry out at least 30 minutes of moderate and low-intensity aerobic exercise every day, such as: slow walking, tai chi, table tennis, badminton, etc., with slight sweating. Sugar friends can choose their own exercise style under the guidance of a doctor and make an exercise plan.
5. Regular follow-up. There is also an early warning signal called diabetic peripheral neuropathy, when peripheral neuropathy occurs, the risk of glucose foot will be greatly increased, which needs to cause sugar friends to be vigilant, and should be regularly screened and evaluated by specialists. When peripheral neuropathy is not present, sugar friends should be screened at least once a year; if peripheral neuropathy has occurred, they should be screened every 6 months; if peripheral vascular lesions and foot malformations are combined, they should be screened every 3 to 6 months; if they have had foot ulcers and a history of amputation, they should be screened every 1 to 3 months. Sugar friends can make follow-up schedules to remind themselves to conduct screening and assessment on time and deal with problems as early as possible.
Prevention Tip 2: Focus on the foot
1. Check the feet every day. Carefully observe the skin of the foot before going to bed and in the morning every day, whether there is edema, small wounds, whether the touch sensation is weakened, whether there is any abnormality in activity, and once there is an abnormality, you must go to the hospital for specialist treatment.
2. Wash your feet properly. Wash your feet daily, do not soak your feet, and dry your feet with a soft, absorbent towel after washing. Especially the toe seams! Try to choose a light towel to check for bleeding or suppuration, and the water temperature is controlled at 37 ° C - 40 ° C. Moisturizer or lubricating lotion can be used when the skin is dry, but be careful not to apply it between the toes to prevent bacteria from growing. Keep the skin of the feet soft, non-drying and non-cracking.
3. Trim properly. Regularly trim the toenails after washing the feet, the toenails should be cut straight, do not cut obliquely or trim too short, the length can be flush with the tip of the toe, and gently smooth after cutting to avoid the feet being bumped by the sharp toenails. If callosum and nail inlay occur, it should be handled by a professional doctor or nurse, and it is forbidden to trim yourself or go to a pedicure shop to repair it.
4. Correctly choose shoes and socks. Choose clean, dry, soft, elastic cotton socks or pure wool socks and change them daily. Shoes with wide toes, sizes and breathability should be chosen. When wearing shoes, the feet must be relaxed and comfortable, and there should be no feeling of grinding or pinching the feet in any part, and do not wear high heels or pointed shoes.
5. Treatment of foot fungal infections. Foot sweating is more susceptible to fungal infections, so the feet should be kept dry; patients with mild tinea pedis can use antibacterial drugs topically according to medical advice; without the guidance of professional doctors, they cannot use antibacterial drugs on their own to prevent improper use of drugs from aggravating the infection.