당뇨병성 족부 궤양의 치료
Management of Diabetic Foot Ulcer
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초록
In patients with diabetic foot, ulceration and amputation are the most serious consequences and can lead to morbidity and disability. Peripheralarterial sclerosis, peripheral neuropathy, and foot deformities are major causes of foot problems. Foot deformities, following autonomicand motor neuropathy, lead to development of over-pressured focal lesions causing the diabetic foot to be easily injured withinthe 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. Applicationof selective dressings that allow a moist environment following complete debridement of the necrotic tissue is mandatory. In thecase 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 footcan 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, andappropriate education regarding footwear.
Abstract
In patients with diabetic foot, ulceration and amputation are the most serious consequences and can lead to morbidity and disability. Peripheralarterial sclerosis, peripheral neuropathy, and foot deformities are major causes of foot problems. Foot deformities, following autonomicand motor neuropathy, lead to development of over-pressured focal lesions causing the diabetic foot to be easily injured withinthe 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. Applicationof selective dressings that allow a moist environment following complete debridement of the necrotic tissue is mandatory. In thecase 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 footcan 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, andappropriate education regarding footwear.
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