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Clinical Observation of Necrotic Diabetic Foot with MEBO
Add Time£º2013/12/17 15:19:11
Clinical Observation of Necrotic Diabetic Foot with MEBO
Li Chuanji, Li Caiyun, Zhang Long and Deng Xingwang from the First People¡¯s Hospital of Shizuishan City of Ningxia Hui Autonomous Region
Diabetic foot results from peripheral neuropathy and microangiopathy due to the protopathy of patients with diabetics. Most of them are unaware of their own conditions. Instead, they became aware by observing the complications. Some patients may suffer from swelling and itching foot and local broken skin at early stage. However, they paid less attention to such conditions, and the diseased foot turned necrotic and stinking very rapidly. Due to that treatment for local diseased parts is not standard, and the humid necrosis will emerge before amputation.
The concept of MEBO refers to technique of cells culturing and corresponding clinical treatment technique to culture potential regeneration cells in situ in an effort to realize in-situ repair of aged organs with defects and infections. Our hospital treated patients with extensive burns, surface tissue ulcers and necrotic diabetic foot and received good results. Now, I will elaborate the details about treatment.
Clinical Information
Altogether, there are 14 cases in this group, all of them are patients with diabetic foot treated between January of 2007 to April of 2012. Among them, six were males and eight were females, aging from 39 to 67, the average age is 56.42 ¡À 3.61. The causes of disease include the following factors: four cases suffered from excessively hot water for washing feet, three cases suffered from too short distance in infrared therapy, five cases of althlete¡¯s foot infections and two cases of frication with shoes or socks. The diseases conditions: twelve cases involve single foot and two cases involve two feet. The defected range on admission is 13cm x 9cm for the largest one and 9cm x 8cm for the smallest one. The diseased foot presented swelling conditions and progressive necrosis, the stinking wounds can be observed on fascia layer. Before their admission, fever, anemia, hypoproteinemia and ion disorder can be observed. The history of diabetes: nine cases of second degree diabetes before admission, accounting for 64.29%, five cases of secondary diabetes diagnosed after admission, accounting for 35.71%. The course of diabetes: it can last for 21 days to 12 years, the average course is 5.36 ¡À 2.64 years. 
Admission Standards based on Diagnosis
Surface ulcer that is not caused by diabetes; the residual wounds caused by deep burn wounds; long-term adoption of glucocorticoid; and long-term adoption of immunosuppressant.
Treatment Methods
The fundamental principle is to treat actively the protopathy and keep blood sugar within safe range, the debridement shall be done to cleanse the inactive necrotic tissues, the purulent secretions in sinus tract and tissue space shall be drained and the local inflammation shall be kept under control to prevent worsening. The MEBO and in-situ regeneration medical techniques shall be adopted to prevent the in-situ regenerative healing of defected parts.
The systemic treatment shall be done to control blood sugar: the enhanced treatment with insulin shall be done with the help of Department of Endocrinology to optimize blood sugar. The blood sugar level shall be kept below 8mmol/L, and the patients who suffer from diabetes for years shall keep their blood sugar level below 9mmol/L. The application of antibiotics: the antibiotics that are efficient in efficacy and sufficient in volume shall be transfused. Such methods are active based on traditional experiences. Then, the volume of antibiotics necessary for human body, the blood albumin and red blood cell suspension liquid shall be supplemented promptly to regulate then to normal level and to realize balanced conditions of nitrogen within a short range of time and to lay a foundation for future regenerative treatment of wounds.
With regard to local treatment, iodophor of 0.5% shall be used to sterilize surrounding skin around the wounds. The hydrogen dioxide solution of 3% and balanced salt water of 0.9% shall be used alternatively on wounds with ulcers for debridement and cleansing of lifeless subcutaneous tissues. The cuttings on swelling parts shall be prolonged, and the unhealthy fascia and muscle shall be removed until the normal tissues can be seen. The sinus tract of spatium interosseum shall be carefully washed and scratched during the secondary washing, and shall be dried with aseptic gauze. Then, MEBO shall be filled into bottom of sinus tract, with a thickness of about 2cm. Before bandaging, bleeding shall be completely stopped. And, the suture of bleeding point shall be paid enough attention to prevent bleeding on wounds after surgery. Dressing shall be changed once every day, and the frequency shall be shifted to once every 12 hours three days later. At early stage, the conditions were not stable, and the pathologic parts can continue expanding. Based on the wounds conditions, wounds shall be washed once every 10 to 15 days. The wounds will not expand after conditions turn stable and the systemic and local inflammation will be kept under control, the progressive necrosis will stop and the wounds enter into the phase of regeneration and restoration. This phase will usually last for 6 to 8 weeks. At this time, the in-situ skin regeneration technique shall be used in standard manner. For patients with extensive burn wounds, stamp skin grafting could be used to promote early healing of wounds and complete the in-situ regeneration process of defected parts.
Treatment Results
In this group, 13 patients were healed clinically, accounting for 92.86%, the healing time of wounds were 84 to 241 days, averagely 106 ¡À 11.21 days. One patient died due to advanced age and cardiopulmonary insufficiency. He gave up treatment 31 days after being admitted and died from multiple organ failure. We tracked 13 patients and reviewed 11 of them.
The review standards can be divided into three levels, good, better and satisfactory. With regard to good results, patients can do ordinary work, with normal functions and outlook. With regard to better results, patients could enjoy basically restored appearance, slight functional failure and could do simple housework and suffer from no local wounds. With regard to poor results, the wounds are not stable and far from being healed, patients could not live by themselves.
The review process can be divided into two phases, the reservation through telephone and clinical diagnosis. Patients shall receive examination of fasting blood glucose and shall be ordered to follow standard treatment methods to keep fasting blood glucose level below 8mmol/L. The review examination shall be done once every 3 months, there were altogether 4 follow-up visits. As for patients with stable conditions, follow-up visits are not required. And such patients shall be ordered to receive treatment for their protopathy and examination in endocrinology. However, for those with unstable and unsatisfactory treatment results, the review time shall be suitable prolonged and reservation shall be done for regular review.
The review results can be divided into the following two levels, good and better. With regard to the former one, 10 cases comply with standards, accounting for 90.91%. And, with regard to the latter one, 1 case complies with standards, accounting for 9.09%. And, we paid follow-up visits to the other two patients from other regions whose diseased foot of them healed completely. They could do simple housework and the treatment results were satisfactory.
Clinical Discussion
Necrotic diabetes shall be treated with correct systemic treatment methods in order to complete the in-situ regenerative restoration process of skin. The patients with diabetic foot ulcers and slight infections presented with foot deformity, dry skin and cold limbs; patients with severe conditions presented with necrotic ulcers which are major causes of amputation and disability. The in-situ regeneration medical technique can restore functions and appearance of diseased foot, thus preventing pains of amputation. The diabetic foot serves as one of difficult problems in the world. Mastering correct methods of how to use MEBO is critical to adopting in-situ regeneration medical techniques.
Main functions of MEBO include maintaining physically moist environment, reducing evaporation of water, isolating bacteria, nurturing and activating the regeneration of base tissues on wounds. The wounds shall be kept moist by MEBO with effective density in order to make regenerative cells in-situ differentiate epidermis cells, fibroblasts and vascular endothelial cells, promote restoration of tissue cells and realize epithelial healing of wounds. The preparation can fully give play to the four biochemical reactions, such as hydrolysis, enzymolysis, rancidity and saponification in order to change necrotic tissues from solid form to liquid form and discharge them out of body. Finally, it can realize such functions as anti-inflammation, anti-edema, mutating bacteria and depriving bacteria from pathogenicity, improving and enhancing immunity, improving micro-circulation with its special elements, and it can alleviate pains and spasm, protect heart and kidney functions and maintain balance of body.
Through the special efficacy of MEBO and repeated debridement, the local progressive necrosis can be kept under control, the regeneration and restoration of wounds can be promoted in order to maintain the complete limbs which were intended to be amputated. This is rather popular among patients.

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