Treatment of Diabetic Foot Ulcers With Necrotizing Fasciitis in the Lower Leg Using the STAGE Principles: A Report of 9 Cases With a Literature Review

Abstract

Diabetic foot ulcers (DFUs) combined with necrotizing fasciitis (NF) has rapid onset, involves a wide range of lesions, is difficult to treat, and has a high mortality rate. It has become a clinically critical disease. DFU patients are at high risk for NF. The STAGE principles guide surgical intervention in the treatment of DFU wounds and emphasizes that “based on anatomical layers, the management focuses on blood supply and includes layer-by-layer incision to the infected area, maintenance of effective wound drainage, and step-by-step treatment of the wound.” This work reports the application of the STAGE principles for the treatment of 9 cases of DFUs combined with NF in the lower leg (Wagner grade 3-5). The mean ankle-brachial index was 0.55 (0-0.91, standard deviation [SD] = 0.33), the mean years of smoking were 19.56 years (0-50, SD = 17.83), and the mean cigarette consumption was 9.11 cigarettes/day (0-20, SD = 7.77). The mean duration of ulcers was 45.56 days (3-103, SD = 35.44). Among the 9 patients, only patient no. 9 died, and the mean follow-up time for the other 8 patients was 12 months (3-36, SD = 13.42). In short, the STAGE principles are also applicable to the treatment of DFUs combined with NF in the lower leg.

Distribution and drug sensitivity of pathogenic bacteria in diabetic foot ulcer patients with necrotizing fasciitis at a diabetic foot center in China

“…Without prompt treatment with appropriate antibiotics and/or debridement of infected tissues, patients may develop toxic shock syndrome, leading to multiple organ failure and mortality. However, the result of bacterial susceptibility is not only lagging but also has a high false-negative rate, therefore, it has limited guiding significance for clinical antibiotic application [ 29 ]. Additionally, before the bacterial culture results are available, the choice of antibiotics is mainly based on the doctor’s experience and the severity of the infection [ 26 ].…”

Necrotizing Fasciitis and Diabetic Foot: Results of a Prompt Identification, Surgery and Antibiotic Therapy (P.I.S.A.) Protocol

“…These findings parallel literature reports: studies that distinguish patients according to microbiological profile did not find differences in terms of clinical outcomes. 30 The anaesthesiologist approach, centered on less invasive methods more suitable to such complicated patients ended in no postoperative complications and a little need for pain-killer drugs. 31 Even better than expected compared to the data reported in the literature in these difficult cases.…”

“…These findings parallel literature reports: studies that distinguish patients according to microbiological profile did not find differences in terms of clinical outcomes. 30…”

Still Science in the Summer

“…Yin et al 10 have demonstrated that autologous stromal vascular fraction cells plus platelet-rich plasma improve the healing of chronic lowerextremity ulcerations in subjects with diabetes mellitus. Zhu et al 11 have found that preconditioning local vibrations might help towards the prevention of foot ulcers in high-risk subjects.The issue is completed by case reports [12][13][14][15] and letters. This journal is unswerving in its mission to advance our knowledge of wound healing.…”

“…The issue is completed by case reports [12][13][14][15] and letters. This journal is unswerving in its mission to advance our knowledge of wound healing.…”