To analyze and summarize the clinical characteristics and treatment experience of the diabetic foot.

The clinical data of 43 patients with severe diabetic foot treated in the department of Burns and Plastic Surgery in Beijing Chaoyang Emergency Medical Center from June 2013 to August 2017 were retrospectively analyzed, and 43 patients were divided into 4 groups: amputation group, cutoff toe group, amputation (toe) group and non-amputation (toe) group. The age, duration of diabetes, hospitalization time, serum albumin concentration, hemoglobin level, white blood cell count, glycosylated hemoglobin level, blood glucose level, Wagner grade, with or without diabetic peripheral neuropathy, ocular retinopathy, diabetic nephropathy, necrotizing fasciitis of patients in 4 groups were analyzed. The data were analyzed by one-way ANOVA, multivariate non-conditional Logistic regression analysis, independent sample t-test and chi-square test.

The hospitalization time of patients in amputation group was (80.7 ± 39.3) d, it was longer than that in non-amputation (toe) group′s (58.4 ± 14.2) d, the difference was statistically significant (t=-2.27, P=0.03); the age of patients in amputation (toe) group, amputation group and cutoff toe group were (58.7 ± 9.8), (55.7 ± 11.2) and (62.2 ± 6.7) years, compared with the non-amputation (toe) group′s (59.0 ± 8.4) years, there were no statistically significant differences (t= 0.12, 0.96, -1.07, P = 0.91, 0.35, 0.29). The duration of diabetes was (13.4±6.4), (12.3 ± 7.1), and (14.6 ± 5.5) years in the amputation (toe) group, the amputation group and the cutoff toe group, which were significantly higher than that in the non-amputated (toe) group′s (15.4 ± 6.3) years, the differences were not statistically significant (t= 1.03, 1.29, 0.32, P= 0.31, 0.21, 0.75). The plasma albumin concentrations in amputation (toe) group and amputation group were (21.9 ± 3.0), (20.9 ± 2.4) g/L, which were significantly lower than that in non-amputated (toe) group′s (25.0 ± 4.5) g/L, the differences were statistically significant (t=2.80, 3.04, P= 0.01, P <0.05). The hemoglobin levels of patients in amputation (toe) group, amputation group and cutoff toe group were (93.1 ± 14.2), (91.8 ± 13.5) , (94.6 ± 15.5) g/L, compared with the non-amputation (toe) group′s (101.4±14.9) g/L, there were no significant differences (t= 1.86, 1.85, 1.19, P=0.07, 0.07, 0.25). The counts of white blood cells in the amputation (toe) group, amputation groups and cutoff toe group were (23.1 ± 4.3), (23.7 ± 4.8), (22.4 ± 3.9)×10⁹/L, compared with the non-amputation (toe) group′s (21.8 ± 3.6)×10⁹/L, the differences were not statistically significant (t=-1.08, -1.30, -0.46, P= 0.29, 0.20, 0.65); The glycosylated hemoglobin levels in the 3 groups were (9.8 ± 1.2), (10.1 ± 1.3) and (9.6 ± 1.1) mg/dl, compared with the non-amputation (toe) group′s (9.4 ± 1.5) mg/dl, the differences were not statistically significant (t=-0.98, -1.21, -0.28, P= 0.16, 0.03, 0.98). Of the 43 patients, 13 cases were amputated and the amputation rate was 30.23%. Amputation incision was performed in 2 cases at the first stage. Eleven cases were amputated toe, the amputated toe rate was 25.58%, and the amputation (toe) rate was 55.81%. The number of patients in amputation (toe) group and amputation group was high Wagner grade, and among them, there were 11 and 19 cases of degree 4, compared with the 7 cases in non amputation (toe) group, the differences were statistically significant (χ²=7.91, 9.73, P<0.05, P=0.02). Patients in amputation (toe) group combined with peripheral neuropathy, lower extremity vascular disease, retinopathy, diabetic nephropathy and necrotizing fasciitis patients were 12, 10, 6, 7, 21 cases, in amputation group, patients combined with these 5 diseases were 8, 7, 4, 4, and 12 cases, and in cutoff toe group patients with those 5 diseases were 4, 3, 2, 3, and 9 cases. Compared with the 3, 5, 3, 6 and 14 cases in non amputation (toe) group, the differences were not statistically significant (χ²=2.57, 3.07, 1.05, P=0.63, 0.55, 0.90).

Severe diabetic foot has higher amputation disability rate, local severe infection is the important cause of amputation and cutoff toe. The treatment of diabetic foot requires comprehensive treatment, and the thorough debridment and drainage is the key measure to treat diabetic foot.