Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Aug 15, 2023; 14(8): 1323-1329
Published online Aug 15, 2023. doi: 10.4239/wjd.v14.i8.1323
Sequential treatment for diabetic foot ulcers in dialysis patients: A case report
Jin-Jun Wang, Yuan-Yuan Yu, Pin-Yi Wang, Xian-Ming Huang, Xiao Chen, Xi-Guang Chen
Jin-Jun Wang, Xi-Guang Chen, College of Marine Life Science, Ocean University of China, Qingdao 266003, Shandong Province, China
Jin-Jun Wang, Yuan-Yuan Yu, Pin-Yi Wang, Xian-Ming Huang, Xiao Chen, Department of Vascular Surgery, Qingdao Haici Hospital Affiliated to Qingdao University, Qingdao 266033, Shandong Province, China
Author contributions: Wang JJ contributed to the guarantor of integrity of the entire study; Wang JJ, Chen XG, and Huang XM contributed to clinical study and experimental study; Wang PY and Yu YY contributed to data analysis; Wang JJ and Yu YY contributed to manuscript writing and editing; all authors have read and approved the final manuscript.
Informed consent statement: The patient has signed informed consent form.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xi-Guang Chen, MD, Professor, College of Marine Life Science, Ocean University of China, No. 5 Yushan Road, Qingdao 266003, Shandong Province, China. xiguangchendr@yeah.net
Received: April 24, 2023
Peer-review started: April 24, 2023
First decision: May 8, 2023
Revised: May 16, 2023
Accepted: July 14, 2023
Article in press: July 14, 2023
Published online: August 15, 2023
Processing time: 109 Days and 3.1 Hours
Abstract
BACKGROUND

Diabetic foot ulcers (DFUs) are common in patients with diabetes, especially those undergoing hemodialysis. In severe cases, these ulcers can cause damage to the lower extremities and lead to amputation. Traditional treatments such as flap transposition and transfemoral amputation are not always applicable in all cases. Therefore, there is a need for alternative treatment methods.

CASE SUMMARY

This report describes a 62-year-old female patient who was admitted to the hospital with plantar and heel ulcers on her left foot. The patient had a history of renal failure and was undergoing regular hemodialysis. Digital subtraction angiography showed extensive stenosis and occlusion in the left superficial femoral artery, left peroneal artery and left posterior tibial artery. Following evaluation by a multidisciplinary team, the patient was diagnosed with type 2 DFUs (TEXAS 4D). Traditional treatments were deemed unsuitable, and the patient was treated with endovascular surgery in the affected area, in addition to supportive medical treatment, local debridement, and sequential repair using split-thickness skin and tissue-engineered skin grafts combined with negative pressure treatment. After four months, the wound had completely healed, and the patient was able to walk with a walking aid.

CONCLUSION

This study demonstrates a new treatment method for DFUs was successful, using angioplasty, skin grafts, and negative pressure.

Keywords: Diabetic foot, Dialysis, Plantar and heel ulcers, Percutaneous transluminal angioplasty, Tissue-engineered skin, Wound repair, Case report

Core Tip: Diabetic foot ulcers can be a serious and common complication of diabetes. In severe cases, they can lead to lower extremity damage and amputation. Traditional treatments such as flap transposition and transfemoral amputation are not always applicable in all cases. This report describes the successful treatment of ischemic diabetic plantar and heel ulcers in a patient undergoing hemodialysis using sequential treatment involving percutaneous transluminal angioplasty, tissue-engineered skin grafts, and negative pressure wound therapy. This treatment method may be a viable alternative for patients who are unsuitable for traditional treatments and could help prevent the need for amputation.