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Diabetic foot ~~ viewpoint from a surgeon
本文探讨糖尿病足的临床表现、诊断和治疗。强调了糖尿病足的严重性及其导致截肢的风险，并介绍了评估和治疗的各个阶段，包括预防措施和跨团队协作的重要性。文献引用展示了对糖尿病足管理的最新指南和研究。
Diabetic foot ~~ viewpoint from a surgeon
- 1. ～～從外科觀點出發 高醫大附設醫院 整形外科 黃昱豪 2013.12.22(日)
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- 9. 臨床場景 一 • 48 y/o male • type II DM for 5 years • OAD(+), F/U at clinic • Le@ big toe ulcer 2wks • Fever since yesterday • WBC:18700, CRP 150 • HbA1c:9.7
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- 11. 臨床場景 二 • 67 y/o female • DM, HTN, old CVA • Bedridden, nursing home • Le@ big toe wound 2mon • Fever since yesterday • WBC:28700, CRP 250 • HbA1c:8.7
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- 32. Claw toe & Hammer toe
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- 38. Transcutaneous oxygen pressure (TcPO2)
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- 43. Wagner Classification • Grade0: no skin lesion • Grade 1: superficial ulceration • Grade 2: deep ulceration involving subcutaneous tissue • Grade 3: osteomyelitis • Grade 4: forefoot gangrene • Grade 5: hind foot or whole foot gangrene 43
- 45. Wagner grade 1 Wagner grade 2 Debridement, Wound care & InfecZon control
- 46. Wagner grade 3 • Assess PAD • Assess osteomyeliZs • Images • Bone biopsy • AnZmicrobial therapy • RevascularizaZon • Off-‐loading
- 47. Wagner grade 4 Wagner grade 5 AmputaZon & Admission
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- 51. SURGERY • Secondary healing • Skin gra@ • Local flap • Distant flap
- 52. ADVANCED THERAPIES • NegaZve pressure • Skin subsZtutes wound therapy • Growth factor • Hyperbaric oxygen
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- 57. 預防 勝於治療
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- 63. REFERENCES l UpToDate 2013 Ø Clinical manifestaZons, diagnosis, and management of diabeZc infecZons of the lower extremiZes Ø EvaluaZon of the diabeZc foot Ø Management of diabeZc foot lesions l Diabe0c Foot Infec0ons: Current Diagnosis and Treatment 2012 l Prac0cal guidelines on the management and preven0on of the diabe0c foot 2011 l Diabe0c foot disorders. A clinical prac0ce guideline (2006 revision)
- 64. ＠糖尿病足潰瘍治療順序 • 儘速控制感染：抗生素 • 評估下肢血管：PE，Doppler， 血管攝影 • 增加血液循環之藥物 • 動脈繞道手術 • 外科手術： – 清創、截趾、皮瓣等 • 輔助性步驟： – 高壓氧、特殊敷料、生長因子、 遠紅外線等