Management and rehabilitation of moderate-to-severe diabetic foot infection: a narrative review
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Diabetic foot is one of the most devastating consequences of diabetes, resulting in amputation and possibly death. Therefore, early detection and vigorous treatment of infections in patients with diabetic foot are critical. This review seeks to provide guidelines for the therapy and rehabilitation of patients with moderate-to-severe diabetic foot. If a diabetic foot infection is suspected, bacterial cultures should be initially obtained. Numerous imaging studies can be used to identify diabetic foot, and recent research has shown that white blood cell single-photon emission computed tomography/computed tomography has comparable diagnostic specificity and sensitivity to magnetic resonance imaging. Surgery is performed when a diabetic foot ulcer is deep and is accompanied by bone and soft tissue infections. Patients should be taught preoperative rehabilitation before undergoing stressful surgery. During surgical procedures, it is critical to remove all necrotic tissue and drain the inflammatory area. It is critical to treat wounds with suitable dressings after surgery. Wet dressings promote the formation of granulation tissues and new blood vessels. Walking should begin as soon as the patient’s general condition allows it, regardless of the wound status or prior walking capacity. Adequate treatment of comorbidities, including hypertension and dyslipidemia, and smoking cessation are necessary. Additionally, broad-spectrum antibiotics are required to treat diabetic foot infections.
Abstract
Diabetic foot is one of the most devastating consequences of diabetes, resulting in amputation and possibly death. Therefore, early detection and vigorous treatment of infections in patients with diabetic foot are critical. This review seeks to provide guidelines for the therapy and rehabilitation of patients with moderate-to-severe diabetic foot. If a diabetic foot infection is suspected, bacterial cultures should be initially obtained. Numerous imaging studies can be used to identify diabetic foot, and recent research has shown that white blood cell single-photon emission computed tomography/computed tomography has comparable diagnostic specificity and sensitivity to magnetic resonance imaging. Surgery is performed when a diabetic foot ulcer is deep and is accompanied by bone and soft tissue infections. Patients should be taught preoperative rehabilitation before undergoing stressful surgery. During surgical procedures, it is critical to remove all necrotic tissue and drain the inflammatory area. It is critical to treat wounds with suitable dressings after surgery. Wet dressings promote the formation of granulation tissues and new blood vessels. Walking should begin as soon as the patient’s general condition allows it, regardless of the wound status or prior walking capacity. Adequate treatment of comorbidities, including hypertension and dyslipidemia, and smoking cessation are necessary. Additionally, broad-spectrum antibiotics are required to treat diabetic foot infections.
참고문헌 (37)
- Lee CW, "Diagnosis and management of diabetic foot", J Korean Diabetes, 19, pp.168~174 (2018)
- Bae SY, "Treatment of diabetic foot : procedures, surgery, and care", Monthly Diabetes, 289, pp.26~36 (2013)
- Armstrong DG, "Guest Editorial : are diabetes-related wounds and amputations worse than cancer?", Int Wound J, 4, pp.286~287 (2007)
- Shankar P, "A study on quality of life among lower limb amputees at a tertiary prosthetic rehabilitation center", Med J Armed Forces India, 76, pp.89~94 (2020)
- Ahn KJ, "Epidemiology of diabetic foot disease", J Korean Diabetes, 12, pp.72~75 (2011)
- Rubio JA, "Mortality in patients with diabetic foot ulcers : causes, risk factors, and their association with evolution and severity of ulcer", J Clin Med, 9, pp.3009~ (2020)
- Singh N, "Preventing foot ulcers in patients with diabetes", JAMA, 293, pp.217~228 (2005)
- Ahmad A, "Anxiety and depression among adult patients with diabetic foot : prevalence and associated factors", J Clin Med Res, 10, pp.411~418 (2018)
- 최영락, "당뇨병발 절단 환자의 재활 치료", 대한의사협회지, 64(8), pp.537~542 (2021), 대한의사협회[DOI]
- Shi C, "Selection of appropriate wound dressing for various wounds", Front Bioeng Biotechnol, 8, pp.182~ (2020)
- Williams DT, "Diagnosing foot infection in diabetes", Clin Infect Dis, 39(Suppl 2), pp.S83~6 (2004)
- Weigelt C, "Immune mediators in patients with acute diabetic foot syndrome", Diabetes Care, 32, pp.1491~1496 (2009)
- Wang Y, "An update on potential biomarkers for diagnosing diabetic foot ulcer at early stage", Biomed Pharmacother, 133, pp.110991~ (2021)
- Lipsky BA, "Guidelines on the diagnosis and treatment of foot infection in persons with diabetes(IWGDF 2019 update)", Diabetes Metab Res Rev, 36(Suppl 1), pp.e3280~ (2020)
- 서동교, "당뇨병성 족부 궤양의 치료", 대한족부족관절학회지, 18(1), pp.1~7 (2014), 대한족부족관절학회[DOI]
- Erdman WA, "Indexing severity of diabetic foot infection with 99mTc-WBC SPECT", CT hybrid imaging, 2012, pp.35, 1826~1831
- Lauri C, "Comparison of white blood cell scintigraphy, FDG PET", CT and MRI in suspected diabetic foot infection : results of a large retrospective multicenter study, 2020, pp.9, 1645~
- Low KT, "Magnetic resonance imaging of diabetic foot complications", Singapore Med J, 56, pp.23~33 (2015)
- Sherwood A, "Comparison of WBC-SPECT", CT and MRI in diagnosis and evaluation of antibiotic response in diabetic foot osteomyelitis, 2022, pp.63(Suppl 2), 2772~
- Schaper NC, "Practical guidelines on the prevention and management of diabetic foot disease(IWGDF 2019 update)", Diabetes Metab Res Rev, 36(Suppl 1), pp.e3266~ (2020)
- "2023 IWGDF guidelines on the prevention and management of diabetes-related foot disease" (2023)[URL]
- Song JY, "Antimicrobial therapy in diabetic foot infections", J Korean Diabetes, 12, pp.83~87 (2011)
- Schaper NC, "Practical guidelines on the prevention and management of diabetes-related foot disease (IWGDF 2023 update)", Diabetes Metab Res Rev, pp.e3657~ (2023)
- Hong JP, "An algorithm for limb salvage for diabetic foot ulcers", Clin Plast Surg, 39, pp.341~352 (2012)
- Turan Y, "Does physical therapy and rehabilitation improve outcomes for diabetic foot ulcers?", World J Exp Med, 5, pp.130~139 (2015)
- Uustal H, "Prosthetic rehabilitation issues in the diabetic and dysvascular amputee", Phys Med Rehabil Clin N Am, 20, pp.689~703 (2009)
- Ditmyer MM, "Prehabilitation in preparation for orthopaedic surgery", Orthop Nurs, 21, pp.43~51 (2002)
- Hijmans JM, "Pre-operative rehabilitation in lower-limb amputation patients and its effect on post-operative outcomes", Med Hypotheses, 143, pp.110134~ (2020)
- Castillo R, "Chest physical therapy : comparative efficacy of preoperative and postoperative in the elderly", Arch Phys Med Rehabil, 66, pp.376~379 (1985)
- Lee DY, "Surgical treatment of diabetic foot disease", J Korean Diabetes, 12, pp.88~94 (2011)
- Brem H, "Molecular markers in patients with chronic wounds to guide surgical debridement", Mol Med, 13, pp.30~39 (2007)
- Oh TS, "Diabetic foot reconstruction using free flaps increases 5-year-survival rate", J Plast Reconstr Aesthet Surg, 66, pp.243~250 (2013)
- 이호승, "당뇨발의 예방과 치료", 대한의사협회지, 56(3), pp.220~228 (2013), 대한의사협회
- Rezvani Ghomi E, "Wound dressings : current advances and future directions", J App Polym Sci, 136, pp.47738~ (2019)
- Jin Z, "Postoperative delirium : perioperative assessment, risk reduction, and management", Br J Anaesth, 125, pp.492~504 (2020)
- Von Rueden KT, "Pulmonary dysfunction related to immobility in the trauma patient", AACN Clin Issues, 6, pp.212~228 (1995)
- Yoo H, "Study of hospitalization and mortality in Korean diabetic patients using the diabetes complications severity index", BMC Endocr Disord, 20, pp.122~ (2020)