| Diabetic Foot as the popular chronic complications of diabetes, is one of the main factors leading to limb amputation, it was reported that the amputation rate is 15 times of the non-diabetic patients. Common surgical amputation is not only about high plane amputation but also bring a tremendous mental stress to patients which may affect the quality of life seriously. Diabetic foot patients facing the great risk of serious infection, endotoxemia , and septic shock which could be the main cause of death before amputation . It become an important topic that how to control the infection, reduce the amputation plane, save the function as possibility, and improve the life quality of the patients as well.This study is based on years of clinical experience of my tutor and brings out "early-stage amputation" concept firstly in China with a systematic exposition, experimental research and clinical research. Early-stage amputation refers to cut in the normal tissue from the in-flammatory tissue at the junction line of limbs, in order to achieve more retained stump, block endotoxin absorption and improve the quality of life of patients. External therapy of herbs chitosan can promote granulation tissue regeneration and control of local infection, it solved the problem of difficult wound healing and it is a reliable guarantee of early-stage amputation.Part One The experimental research on diabetic foot rat treated with early-stage amputation combined with external therapy of herbs chitoson Objective: To study the effect and reliability of early-stage amputation combined with external therapy of herbs chitosan by observing wounds healing, leptin expression in raw surface of and its receptor expression and serum VEGF, IGF-1, ET, NO level of the in SD rats with diabetic foot.Methods: According to the literature generic modeling method made the modeling of diabetic foot rats.135 rats of ulcer degree 3 were randomly divided into three groups : control groupâ… , control group II and experimental group. Control groupâ… underwent a high amputation and general surgical dressing change, control group II underwent early amputation and general surgical dressing and the experimental group underwent early amputation combined with external herbs dressing change. After the modeling, serum and muscle samples were collected for analysis and pathology examination respectively, include wound healing, leptin and leptin receptor expression and serum VEGF, IGF-1, ET , NO level. Results: Wound healing: Healing time of experiment group is slightly longer than control group, superficial fascia structurally well, inflammation extinct, regenerate skin is thicker than control groupâ… and control group II statistically significant.The expression of leptin and leptin receptor levels: In the experimental group, the levels of leptin and its receptor expression is higher, and compared with the control groupâ… showed no significant difference, but express high levels below the dermis. Changes in VEGF: Experimental group VEGF levels is lower than normal before modeling and improved significantly after early-stage amputation combined with external therapy of herbs chitosan. Change in IGF-1: after modeling IGF-1 level in experimental group is significantly lower than normal, and after the treatment IGF-1 level rebounded and close to normal level. Changes in ET:after modeling successfully, ET levels in experimental group is higher than normal level significantly and rebounded to the normal level after therapy. Change in NO: the levels of NO in experimental group is significantly higher than normal level and after therapy dropped to the normal level. Conclusion: 1. Early-stage amputation combined with external therapy of herbs chitoson can promote wounds healing period and close to the healing time of high degree amputation and general surgical changing dressing methods. 2, External therapy with herbs chitosan can promote the leptin and leptin receptor expression ,so as to speed up the wound healing period; 3..External therapy of herbs chitosan can promote regenerated skin thickness significantly; 4. External therapy of herbs chitosan can rise serum VEGF and IGF-1 level, led ET, NO down.Part Two The clinical study on diabetic foot patients treated with early-stage amputation combined with external therapy of herbs chitosonObject: To observe the clinical therapy effect of diabetic foot under early-stage amputation combined with external therapy with herbs chitoson. Methods: We divided 60 cases of diabetic foot patients into three groups randomly from Feb 2007 to Nov 2008. The treatment group was given with early-stage amputation combined with external therapy with herbs chitoson, the control group A was given early-stage amputation and external therapy with Shengjiyuhong ointment, the control group B without traditional medicine only with the routine operation. We compared and analyzed the three groups on the situation of amputation, general reaction, surface of the wound reaction, and the possibility of secondary surgery.Results: In healing level,The treatment group has obviously difference compare with the control group A and the control group B .In period of wound healing, the treatment group is obviously shorter than the control group A, and shows slightly difference with control group B. In amputation level, the treatment group is much lower than the control group B, it has the same result compared with the control group A. There are no differences in infection rate, the incidence of secondary surgery and typical symptoms postoperation.Conclusion: The clinical study shows early-stage amputation plays a very important role, it can promote the patients satisfaction and sensitive affection for diabetic foot patients , it can save more physical function. External therapy with herbs chitoson can reduce the symptoms reaction and the period of wound surface healing.
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