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An Analysis of 54 Cases of Diabetic Lower Limb Ulcers
Add Time£º2011/8/11 16:22:52
Wang Xiang, Shi Min, Wang De-huai, et al.
1.Hospital of Chengdu Military Region Chengdu, Sichuan Province 610011, China;
2. General Hospital of Chengdu Military Region, Chengdu, Sichuan Province 610083, China;
3. The 2nd People¡¯s Hospital, Chengdu City, Sichuan Province 610011, China
[Abstract]Objectives: Lower limb ulcer as a complication of diabetes is difficult to cure. We tried to use MEBO for treating 54 cases of this disease. Method: After debridement, MEBO was applied in bandaging, semi-exposed or exposed way. Blood sugar level was controlled and systemic anti-infective measures were adopted. Result: 44 cases cured. 10cases were subjected to skin flap transplantation. All were discharged from the hospital after healing. The curative rate was 81.5% and the effective rate was 1000%. Conclusion: MEBO has marked effect for treating diabetic lower limb ulcer. It is safe and easy to apply.
[Key words]Skin ulcer Senile Diabetes MEBO Treatment
Lower limb ulcer is one of the severe complications of diabetes, of which the patients always suffer from long period treatment and poor clinic results and mostly have to conduct amputation in the past[1]. It is reported that the rate of amputation of lower limb ulcer reaches up to 38.1%~75.0% [2]. We¡¯ve collected 54 cases of diabetic lower limb ulcer from 1997 to 2002, and treated these cases with MEBO (Moist Exposed Burns Ointment) with a simultaneous systemic treatment of positive controlling of blood sugar and using sensitive antibiotics for anti-infection. All these 54 cases were cured and discharge with a remarkable clinic result.
I. Clinical Data
1.      Among the 54 lower limb ulcer cases, there were 42 male cases and 12 female ones, with an age range of 38~85 years old (average at 54.62¡À8.76years) , and the diabetes course range of 1~22 years (average at 6.3 years). The course of lower limb ulcer last from 37 days to 3 years (average at 5.87months). These patients were treated with diabetic diet and normal/abnormal hypoglycemic drug. Blood sugar at empty stomach: 5 cases lower than 7.0mmol/L (9.3% of the total), 28 cases between 7.1 mmol/L ~10.0 mmol/L (51.9%) and 21 cases between 10.1 mmol/L ~14.5 mmol/L (38.8%). 3 cases were checked for negative glycosuria (5.5% of the total), 23 cases for glycosuria (+~++) (42.6%) and 28 cases for glycosuria (+++~++++) (51.9%).
2.      There were total 71 ulcerative wounds of the 54 cases with the smallest area of 1cm¡Á2cm and largest of 7cm¡Á10cm. There were 15 cases suffered from 18 areas of tendon or bone exposure after debridement. 12 cases suffered from 18 wounds located at the toes, 13 cases for 15 wounds on the instep, 5 cases for 7 wounds at the ankle, 2cases for 2 wounds at the heel, 4 cases for 6 wounds at the sole of foot and 18 cases for 23 wounds at crus anterior tibial site. Cultivated the bacteria on the ulceration surface of 48 cases with a result of 39 positive cases, and totally isolated 52 bacteria including 36 Staphylococcus aureus, 11 Pseudomonas aeruginosa, 2 Streptococcus hemolyticus, 3 Proteus mirabilis and polyinfection for 3 cases. During the treatment of primary affections before admitted to this hospital, the patients didn¡¯t get betterment after treatment of using sensitive antibiotics for anti-infection, conventional dressing change, debridement and etc, and the wound area could not close.
II.             Treatment Method and Result
1.  Treatment method: First of all, clean the ulcerative area and surrounded skin thoroughly with 0.3% chlorhexidine solution and conduct a thorough debridement for the wound surface, exudates eschar, degenerated and darkened necrotic tissues. Then clean the wound surface with 3% hydrogen peroxide and 0.9% NaCl solution respectively and smear MEBO on the wound surface about 2mm~3mm thickness after dried the cleaned wound surface with sterile gauze. Lastly, cover the wound with 4~5 layers of sterile gauze with lower pressure bandage. Exposure or semi-exposure therapy is also doable according to the concrete situation of the wound and conduct dressing change for once or twice a day with a thorough cleaning of liquefied necrotic tissues and exudates. More exudates are discharged at the early stage and gradually decreases after 3~5days. Provide the patients with diabetic diets and try the best to control the blood sugar at an ideal level with use and adjustment of insulin. Meanwhile, apply systemic anti-infection treatment with sensitive antibiotics according to the bacteria cultivation and antimicrobial susceptibility test results.
2.  Treatment results: The blood sugar and urine sugar of all the 54 cases were at averagely ideal level after normal blood sugar controlling treatment. Empty stomach Blood sugar of 24 cases is lower than 7.0mmol/L (44.5% of the total), 26 cases between 7.1 mmol/L ~10.0 mmol/L (51.9%) and 4 cases between 10.1 mmol/L ~14.5 mmol/L (7.4%). 28 cases were checked for negative glycosuria (51.9% of the total), 23 cases for glycosuria (+~++) (42.6%) and 3 cases for glycosuria (+++~++++) (5.5%). After the MEBO treatment, 43 cases were cured in the first period, and the cure rate reach up to 81.5% (44/54) with the shortest treatment course of 13 days and longest for 42 days. After dressing change of 10cases for 14~21days, the necrotic tissues and exudates of were thoroughly discharged; 3 cases were conducted amputation of the toes due to the extensively large area of tendon and bone exposure; 8 cases were applied skin flaps transplantation therapy to close the wounds.
III.           Discussion
Diabetic lower limb ulcer and gangrene is a chronic and progressive vascular lesion, which is mainly caused by acro-ischemia, neuropathy, infection and other induced factors. The pathology base of such disease is that the atherosclerosis of artery and arteriole leads to stenosis and blockages of vascular cavity, and further leads to ischemia and hypoxia of tissues and organs in charged, which finally causes ulcer or gangrene that can not be cured even after long term treatment [3].  This disease happens more frequently in the elders with a high disability rate. It is reported by Pan Tianpeng and others that the rate of amputation of lower limb ulcer reaches up to 38.1%~75.0% [2]. Diabetic ulcer and gangrene is very tough to treat, while after MEBO treatment, the cure rate of the patients reach up to 81.5%(44/54) with an amputation rate of 5.0%(3/54). The main effects of MEBO include:
1.  The main active ingredients of MEBO include nature ¦Â-sitosterol, baicalin, berberine and etc., with the functions of anti-infection, prevention of bacteria invasion, antibacterial, and promotion of the degeneration of bacteria, destroying the survival environment of bacteria, depriving the tropism towards living tissues of bacteria and lowering the toxics [4]. The experiments proved that MEBO shows a relatively strong broad spectrum antibacterial effect on G+ aerobe, G- bacteria, G+ sporiparous anaerobe and G+ non-sporiparous anaerobe [5]. Meanwhile, during MEBO treatment, the bacterial infection can be thoroughly controlled together with sensitive antibiotics treatment.
2.  MEBO helps improve the blood circulation, remove the necrotic tissues and promote the regeneration and recuperation of wound. MEBO also can improve the growth of blood vessels of living tissues of deep wound layer, increase the blood flow and enrich the blood circulation [6]; thus improve the blood circulation of diabetic ulcer, gangrene area or wound surface, resume the blood flow in the blocked microcirculation of basal site, and provide the tissue cells on the wound surface with nutrition and oxygen again. Meanwhile, it helps promote the regeneration of epidermis cells, suppress the rehabilitation of fibrous tissues and keep the growth of epidermis cells and collagenous fiber near to a normal proportion [7]. MEBO is a medicinal oil ointment, and it can help form a stereoscopic moist physiological environment. During the application, it turns from a solid form to liquid and helps liquefy and discharge the necrotic tissues of the wound surface without further damage, thus prevents progressive damage and gradually restore the wound surface through the regeneration of epithelioid cells.
3.  MEBO has remarkable anti-itching and pain relieving effect. For the diabetes patients, due to the corrosion of ulceration, the nerve endings will be exposed in the air and many chemical mediator will be produced in regional tissues, which will irritate free nerve endings in the intra-epidermal and dermal layer and cause skin itching. For most of the patients, the pain and itching will be relieved or eliminated 10 minutes after use of MEBO and they will positively cooperate on the treatment [8]. MEBO contains the ingredients for Activating blood and dissolving stasis as well as anti-itching and swelling reducing.[10] , which have significant effects on improvement of regional blood circulation and help achieve painkilling and swelling reducing results.
4.  Positive treatment of primary affections should be conducted together with MEBO treatment. Since diabetic patients generally suffer from abnormal body glucose metabolism, higher blood sugar level, poorer tissue rehabilitation ability, the wounds of such patients always are hard to close and the treatment requires controlling the blood sugar near to the normal level as much as possible. Regarding to blood sugar control, the sources of infection should be discharged in time besides the general diet control and intake of glucose-lowering drugs. At the same time of normal diabetes treatment, MEBO is applied to discharge the ulcerative necrotic tissues, control infection and restore the wound surface, which has played an indispensable role in the ideal controlling of blood sugar for most of the patients.
[1] Huang Hanyuan, Zhu Yu, ¡°Lower Limb Vascular Diseases [M]¡±, in ¡°Diabetology¡± by Chi Shengzhi, Chief Editor, People's Health Publisher, Beijing, 1982, 328
[2] Pan Tianpeng, ¡°Treatment of Diabetic Arteriosclerosis Obliterans and Diabetic Acromelic Gangrene [M]¡± in ¡°Diabetes in China¡± by Qi¡¯ An, Chief Editor, Hunan Science and Technology Press, Hunan, 1989, 312
[3] Li Shiming, Zhu Xi¡¯e, Shi Guozhen, eds, ¡°Comprehensive Treatment of Diabetic Acromelic Gangrene [J]¡± in ¡°Chinese Medical Journal¡±, 1994, 6:358
[4] Li Shimin, Chang Guihua, Jiang Wenquan, eds, ¡°Experiences of Application of Moist Exposed Burns Ointment and Biological Dressing on 84 Cases of Obstinate Ulcers [J]¡± in the Chinese Journal of Burns, Wounds& Surface Ulcers, 2002,14(3): 174-175.
[5] Qu Yunying, Xie Changhua eds, ¡°Experimental Studies on MEBO¡¯s Antibacterial Effect¡±, the Chinese Journal of Burns, Wounds& Surface Ulcers, 1998, 10(4): 15.
[6] Xu Rongxiang, ¡°Chinese Medical Science of Burns, Wounds and Ulcers[M]¡±, the Chinese Journal of Burns, Wounds& Surface Ulcers, 1997, 9(3): 53-170
[7] Xu Rongxiang, ¡°New Development of Modern Surgery[M]¡±, the Medicine Science and Technology Press of China, 1998, 18-48
[8], Xiao Mo, ¡°Clinic Observation of MEBT/MEBO Promotion on Regenerative Restoration of Deep Burns Wound¡±, the Chinese Journal of Burns, Wounds& Surface Ulcers, 1999, 219.
[9] Shi Min, Wang Xiang, ¡°Experience with MEBO in treating 18 Cases of Senile Diabetic Skin Ulcer [J]¡±, the Chinese Journal of Burns, Wounds & Surface Ulcers, 2002, 14(3): 182-183.
[10] Xu Rongxiang, ¡°General Medical Science for Burns, Wounds and Ulcers I¡±, the Chinese Journal of Burns, Wounds& Surface Ulcers, 1989, (1):22.
Brief Introduction of the authors:
Shi Min (1964- ), Female, Yibing in Sichuan Province, graduated from Department of Nursing in the Fourth Military Medical University of PLA, Head Nurse, Supervisor Nurse.
Wang Xiang (1964- ), Male, Chongqi City, graduated from the Department of Medicine in the Luzhou Medical School, Sichuan Province, Vice Chief Doctor in Surgical Department, Attending Doctor
Wang Dehuai(1965-), Male, Chengdu in Sichuan, graduated from the Thrid Military Medical University of PLA, Master Degree, engaged in burns plastic surgery, Vice Chief Doctor

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