ObjectiveTo explore the clinical efficacy of ultrasound debridement combined with autolytic debridement in the treatment of diabetic foot ulcers.MethodsA total of 60 diabetic foot ulcers patients who were diagnosed and treated in Jinshan Hospital of Fudan University from April 2019 to April 2020 were enrolled in the study and randomly divided into two groups, with 30 cases in each group. The trial group received autolytic cleansing combined with ultrasound debridement treatment, and the control group only received autolytic debridement treatment. The baseline conditions, wound treatment efficacy, number of dressing changes, length of hospital stay, treatment cost, wound healing time, wound shrinkage rate, and the time required for the wound to turn into 100% red granulation were compared between the two groups.ResultsThere was no statistically significant difference in gender, age, duration of diabetes or Wagner grade of diabetic foot between the two groups (P>0.05). The efficacy of wound healing in the trial group was better than that in the control group (Z=?2.146, P=0.032). The number of dressing changes [(11.76±2.23) vs. (17.34±4.43) times] and the length of stay [(18.03±3.73) vs. (25.43±4.43) d] in the trial group were lower than those in the control group, and the differences were statistically significant (P<0.05). The difference in treatment cost between the two groups was not statistically significant (P>0.05). The wound healing time of the trial group [(48.43±18.34) vs. (65.24±19.62) d], the wound shrinkage rate [(78.35±8.34)% vs. (56.53±6.54)%] and the time required for the wound to turn into 100% red granulation [(16.34±2.42) vs. (24.55±3.23) d] were better than those of the control group, and the differences were statistically significant (P<0.05). During the treatment process, no patient in the trial group had wound bleeding and had difficulty in stopping bleeding during ultrasonic debridement, and no patient had intolerable pain related to ultrasonic debridement. No patients in either group withdrew early.ConclusionsUltrasound debridement combined with autolytic debridement can effectively improve the curative effect of patients with diabetic foot ulcers and shorten the wound healing time. Therefore, it is worthy of promotion and application in the wound care of patients with diabetic foot ulcers.
ObjectiveTo evaluate the value and experience of a multi-disciplinary team (MDT) approach in the management of patients with lower extremity arteriosclerosis obliterans (ASO). MethodsA retrospective analysis was conducted of 46 consecutive patients with ASO who were treated with MDT model at Zhongshan Hospital, Fudan University, from May 2021 to April 2024. All subjects had critical limb ischemia (Rutherford grade 4 or more) and at least one major organ dysfunction. Overall mortality, above-ankle amputation rate, and below-ankle amputation rate were recorded. The frequency and depth of involvement of each specialty in the MDT process were also documented. ResultsOf the 46 patients, 37 (80.4 %) were male and 9 (19.6 %) were female, with a mean age of (74.33±11.8) years. Major comorbidities included diabetes mellitus in 40 cases, cardiac disease in 30, hypertension in 31, renal insufficiency in 22, prior cerebral infarction in 14, and chronic obstructive pulmonary disease in 11. Overall mortality was 13.04% (6/46). The total amputation rate was 32.61% (15/46), comprising above-ankle amputation in 19.57% (9/46) and below-ankle amputation in 13.04% (6/46). Seventeen disciplines participated in the MDT; in addition to vascular surgery, the most actively involved departments were endocrinology, cardiology, and nephrology. ConclusionThe MDT model offers unique advantages in the management of critical lower-extremity ASO. By coordinating revascularization timing, extent, and modality, prioritizing comorbid conditions, tailoring operative plans, and optimizing peri-operative support, the MDT approach reduces mortality, improves limb-salvage rates, and enhances both prognosis and quality of life.
