Foot ulcers and amputations in diabetes

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1、main/0602_new31/10/06DiabetesFootulcersandamputationsindiabetesSearchdateSeptember2005DereckHuntQUESTIONSWhataretheeffectsofpreventiveinterventionsinpeoplewithdiabetes?..............2Whataretheeffectsoftreatmentsinpeoplewithdiabeteswithfootulceration?.........4INTERVENTIONSPREVENTIONSyste

2、michyperbaricoxygen(forinfectedLikelytobebeneficialulcers)........................7ScreeningandreferraltofootcareclinicsTopicalgrowthfactors................6..............................0UnknowneffectivenessUnknowneffectivenessHumancultureddermis..............5Education..................

3、......3Pressureoff-loadingwithfeltedfoamorTherapeuticfootwear................3pressurereliefhalfshoe............4TREATMENTSystemichyperbaricoxygen(fornon-infectedBeneficialnon-ischaemiculcers)..............7Pressureoff-loadingwithnon-removablecast..............................0Seeglossary

4、
LikelytobebeneficialHumanskinequivalent...............6KeyMessages•Diabeticfootulcerationisfullthicknesspenetrationofthedermisofthefootinapersonwithdiabetes.SeverityisclassifiedusingtheWagnersystem,whichgradesitfrom1to5.Theannualincidenceofulcersamongpeoplewithdiabetesis2.5-10.7%inthedev

5、elopedworld,andtheannualincidenceofamputationforanyreasonis0.25-1.8%.Forpeoplewithhealeddiabeticfootulcers,the5yearcumulativerateofulcerrecurrenceis66%andofamputationis12%.•Themosteffectivepreventativemeasureappearstobescreeningandreferraltoafootcareclinicifhighriskfeaturearepresent.Other

6、interventionsforreducingtheriskoffootulcersincludewearingtherapeuticfootwareandincreasingpatienteducationforprevention,butwedidnotfindsufficientevidencetoascertaintheeffectivenessofthesetreatments.•Pressureoff-loadingwithtotalcontactcastingornon-removablefibreglasscastssuccessfullyimprove

7、shealingofulcers.Removablecastwalkersrenderedirremovableappeartobeequallyaseffective,buthavetheaddedbenefitofrequiringlesstechnicalexpertiseforfitting.Wedidn’tfindsufficientevidencetojudgewhetherpressureoff-loadingwithfeltedfoamorpressurereliefhalfshoeswereaseffecti