Abstract
Background
Currently, clearing infections and repairing wounds are the main treatment for diabetic foot. However, statistics indicate that most cases of diabetic foot are caused by neuropathy alone or combined with vascular disease. In such cases, follow-up Neurotherapy plays a crucial role in managing diabetic foot patients. This study aimed to investigate the efficacy of using the CRN’s (Control infection, C; Repair wound, R; Neurolysis, N) three-stage approach in treating infected neuropathic diabetic foot.
Methods
A retrospective analysis was conducted on 84 diabetic foot patients with infection, ulceration, local gangrene, and neuropathy who were admitted to the Second Affiliated Hospital of Soochow University between March 2019 and March 2022. The treatment protocol involved complete surgical debridement in the first stage, wound repair surgery in the second stage, and the performance of Dellon triple neurolysis treatment three months after complete wound healing. The rate of foot sensory relief and the change of two-point discernment were compared before and after the operation.
Results
Following the operations, out of the 84 diabetic foot patients, 3 patients were treated with amputation due to progressive aggravation of infection and necrotizing fasciitis, while 81 underwent stages 2 and 3 of the treatment. Over an 8–18 months follow-up period, 3 patients were lost to follow-up, leaving 78 patients for analysis. Among them, 70 patients experienced successful wound healing without diabetic foot recurrence after the three-stage treatment, leading to successful limb preservation. 6 patients had diabetic foot recurrence but were readmitted for further treatment, resulting in successful wound repair and limb preservation. 2 patients passed away due to complications. Post-operation, neurologic symptoms improved in 76 patients who were followed up successfully, with a 95.9% foot sensory relief rate three months after the surgery, indicating positive outcomes. Additionally, two-point discrimination significantly improved three months post-surgery compared to pre-surgery levels, with statistical significance (P < 0.01).
Conclusion
The CRN’s three-stage surgical approach proves to be an effective method for treating infected neuropathic diabetic foot. It can shorten the hospital stay, regulate the treatment course, improve the limb-saving rate, and reduce the recurrence of diabetic foot.