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DiabeticfootulcersandinfectionsWangZheng2020-05-26cataloguediabetesfootPart2TheharmofdiabeticfootPart3Listofrecommend-ationsPart5ProspectofdiabeticfootPart4BacteriologyofdiabeticfootinfectionOverviewofdiabeticfootulcersandinfectionsPart1Part1Overviewofdiabeticfootulcersandinfections1hyperglycemia2Nerveandvasculardisease3Footulcers,gangrene,amputationThethreestagesofdiabeticfootdiseasePart1OverviewofdiabeticfootulcersandinfectionshyperglycemianeuropathyanesthesiaMuscularatrophyandfootdeformitychappedskinandcallusesperipheralvasculardiseaseIschemiaofthefootFootulcers•infectiongangreneamputationDifficultyinvascularreconstructionThedevelopmentofdiabeticfootPart1OverviewofdiabeticfootulcersandinfectionsMechanismsofdiabeticfootinfectionimmunologicderangementNeurologicdisordervasculardiseaseDiabeticUlcerinfectionDepressedfunctionsofneutrophilsIschemiaImpairedhealingfunctionPoorbloodoxygen,nutritionandantibioticsupplyvegetativenerve：dryandcrackedskinsensorynerve：Inabilitytoperceivedamagemotornerve：Biomechanicalanomaly1.ArmstrongDGetal.DiabetesTechnolTher.2004;6:167–177.2.LipskyBAetal.ClinInfectDis.2004;39:885–910.Part1OverviewofdiabeticfootulcersandinfectionsDiabeticFootUlcers--epidemiologyArmstrong,D.G.,etal.2017.Diabeticfootulcersandtheirrecurrence.N.Engl.J.Med.376:2367–2375•Onthebasisof2015prevalencedatafromtheInternationalDiabetesFederation,itisestimatedthat,annually,footulcersdevelopin9.1millionto26.1millionpeoplewithdiabetesworldwide.•Theproportionofpersonswithdiabetesandahistoryoffootulcerationisunderstandablyhigherthantheproportionwithanactiveulcer;3.1to11.8%ofpersonswithdiabetes,or12.9millionto49.0millionpersonsworldwideand1.0millionto3.5millionintheUnitedStatesalone,haveahistoryoffootulceration.•Thelifetimeincidenceoffootulcershaspreviouslybeenestimatedtobe15to25%amongpersonswithdiabetes,butwhenadditionaldataareconsideredbetween19%and34%ofpersonswithdiabetesarelikelytobeaffected.Part1OverviewofdiabeticfootulcersandinfectionsDiabeticFootUlcersandinfectionArmstrong,D.G.,etal.2017.Diabeticfootulcersandtheirrecurrence.N.Engl.J.Med.376:2367–2375•Thenaturalhistoryofadiabetes-relatedfootulcerissobering.•Morethanhalfofdiabeticulcersbecomeinfected.•Peripheralarterydiseaseindependentlyincreasestheriskofnonhealingulcers,infection,andamputation.•Approximately20%ofmoderateorseverediabeticfootinfectionsleadtosomelevelofamputation.•Theriskofdeathat5yearsforapatientwithadiabeticfootulceris2.5timesashighastheriskforapatientwithdiabeteswhodoesnothaveafootulcer.•Theriskofdeathat10yearsforapatientwithdiabeteswhohashadafootulceristwiceashighastheriskforapatientwhohasnothadafootulcer.Part1OverviewofdiabeticfootulcersandinfectionsDiabeticFootUlcersArmstrong,D.G.,etal.2017.Diabeticfootulcersandtheirrecurrence.N.Engl.J.Med.376:2367–2375Thisfigureshowsthepathogenesisofatypicaldiabeticfootulcer：Diabeticfootulcersarecommonlycausedbyrepetitivestressoveranareathatissubjecttohighverticalorshearstressinpatientswithperipheralneuropathy.Peripheralarterydisease,whenpresent,alsocontributestothedevelopmentoffootulcers.Diabeticfootulcersandtheirrecurrencesarecausedbyanumberoffactorsthatultimatelyleadtoskinbreakdown.Thesefactorsincludesequelaerelatedtosensory,autonomic,andmotorneuropathies.Part1OverviewofdiabeticfootulcersandinfectionsDiabeticfootinfection1.ArmstrongDGetal.DiabetesTechno...