| BACKGROUND Diabetic foot refers to local neurological abnormalities in diabetic patients and Foot infection,ulceration,and/or deep tissue destruction caused by peripheral vascular disease at the distal extremity.Diabetic foot is developed on the basis of diabetes and is one of the most serious complications in the development of diabetes.In China,about one-tenth of the population has new diabetes every year,and About a quarter of the population will develop diabetic foot.At present,there are various methods for treating diabetic foot in clinical practice,but the effect is not good,and many patients eventually have to face the outcome of amputation.Therefore,limb salvage has become the biggest appeal of patients with diabetic foot.However,with the increase of Wagner classification,the risk of amputation of patients has increased sharply,especially for severe diabetic foot above Wagner level 3.Local infection is easy to besecondary,and local problems and systemic interactions are vicious,resulting in many patients.It leads many patients to be forced to choose amputation as a final treatment to preserve their lives.Transverse bone movement of the tibia is a method for the treatment of chronic ischemic diseases of the lower extremities based on Ilizarov’s "tension-stress" rule.We used Ilizarov’s technical tibial lateral bone transfer to treat severe diabetic foot,and achieved good results in effectively promoting tissue wound healing and alleviating systemic symptoms.However,the promoting mechanism is still not fully understood.As we all know,wound repair is a series of continuous and complex processes.When the body is damaged,the tissues or cells surrounding the wound will secrete various growth factors by autocrine or paracrine.Although these factors are minimal in wound tissue,they play a very important role in wound repair.Blood vessels are also one of the important carriers in the human body.They are the main transmission pathways for human nutrients,metabolites and some biologically active substances.Capillaries are an important part of granulation tissue.The time,quality and quantity of capillary formation will affect the substances,energy and the removal of metabolites necessary for wound repair.Some scholars have shown that the formation of blood vessels is involved in many pathological and physiological processes,especially in the process of wound repair,which requires a large number of sufficient new blood vessels to provide nutrients for the wound tissue to promote wound healing.Neovascular disorders or delays are the main cause of delayed wound healing.If the number of wound vesselsincreases,the healing time of the wound will be shortened.Therefore,the recovery of blood flow in damaged tissue is a necessary condition for successful repair of wounds.Transverse bone movement of the tibia can promote the formation of capillaries and increase the number of blood vessels in the wound,which can cure the ulcer at the wound surface of patients with severe diabetic foot.METHOD 1.We collect a total of 249 patients with severe diabetic foot who were treated with tibial transverse transport at the Department of Osteoarthritis at the First Affiliated Hospital of Guangxi Medical University from July 2014 to October 2018.The basic data(age,sex,Wagner classification,duration of diabetes,duration of diabetic foot,etc.),the average time of wound healing,the amputation rate,the recurrence rate and the effect of tibial transverse transport for severe diabetic foot was initially evaluated.2.Peripheral blood was taken before surgery and 1 month after surgery,and the concentration of stromal cell-derived factor-1(SDF-1)in peripheral blood was determined by enzyme-linked immunosorbent assay(ELISA).19 patients in each group in the first month after surgery.3.After consultation with the patient,the tissue was sliced at the edge of the wound before and 1 month after surgery,and the structure was observed under HE staining.And Immunohistochemical technique was used to label vascular endothelial cells with VEGFR-1 monoclonal antibody and CD31 monoclonal antibody.Image pro plus 6.0 software image analysis function was used to calculate positive cell rate and microvessel volume,preoperative group and postoperative month.Each group consisted of 10 patients.RESULTS: 1.Of the 249 patients with severe diabetic foot,3 had amputation due to acute embolization of the superficial femoral artery,and the amputation rate was 1.2%.17 patients had recurrence within 1 to 2 years after wound healing,and the recurrence rate was 6.8%.The average healing time of the wound was(3.8 ± 2.6)months.2.After 1 month of operation,the tissue at the edge of wound healing was observed by HE staining,and the intact skin structure could be observed under the microscope.It can be proved that the skin tissue of the severe diabetic foot wound healing was regeneration rather than scar hyperplasia..3.The preoperative SDF-1 concentration was 285.04 ± 50.82(pg/ml)in 19 patients,and the concentration was 364.40 ± 69.99(pg/ml)in January,P<0.05.The difference was statistically significant.The preoperative rate of VEGFR-1 positive cells in 10 patients was 0.33%±0.23% before operation and 2.49%±1.64% after operation,P<0.05.The difference was statistically significant.The preoperative CD31 positive cells rate in 10 patients was 0.43%±0.22% before operation and 1.03%±0.35% after operation,P<0.05.The difference was statistically significant.The microvessel counts of 10 patients were randomized: 19.75 ± 8.57 before operation and 70.92 ± 12.46 after operation,P < 0.05.The difference was statistically significant.CONCLUSION 1.Transverse bone movement of the humerus can promote the healing of severe diabetic foot wounds and is an effective methodfor treating severe diabetic foot.2.The basic characteristics of skin tissue can be observed under the microscope of HE and the HE staining.It can be proved that the lateral bone transfer surgery of the tibia promotes the regeneration of skin tissue at the foot of severe diabetic foot.3.Transverse bone movement of the humerus can promotes the release of SDF-1 and VEGF,thereby promoting a large number of vascular regeneration,so that ulcers can be healed in the wound of severe diabetic foot. |
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