Chery Wang
Shengli Oilfield Central Hospital
Title: Call for neater team healthcare for patients with diabetic foot
Biography
Biography: Chery Wang
Abstract
Regardless of enormous effort we put, diabetic foot remains challenging for physicians, surgeons, scientists, patients, and the society. Diabetic foot is a complicated pathogenesis progress, with nerve, vessels, local pressure, inflammation and infections involved. Better blood sugar control, local debridement, wound care, and tissue regenerative are quite essential for better outcome. Neater team healthcare is essential to prevent leg amputation.
Regular checkup shall be performed by patients themselves on daily basis, by podiatrists on routine visits.
Better diabetes control effort shall be carried by diabetologists, patients, nutrition, diabetic educators and family and social support. Agents softening arteries, blood thinner, anti-platelets, and lipid-lowering may be used on regular basis. Positive attitude and stress management can be practiced by patients, family, psychiatrists, psychologists, activists, social workers.
The local necrotic tissues, infections, inflammation and other insults block the oxygenation and nutrition of the vessels and tissues, and as such prevent the wound from healing. Thorough debridement carried by wound care nurses, surgeons, and practitioners shall lay a whole picture of the patient’s situation, as well as the local blood supply and infections, cautions shall be paid for the direction of tunnels and oozing to make sure excessive discharge drained well, to offer a fresh, better oxygenated, and relatively healthier setting that promotes the growth of new tissues and vessels. Tips like avoiding pressure/weight on the foot, elevation of the lower limbs, comfort and fit footwear and shoes, regular self-checking of the feet with/without mirror shall reminded and urged by patients themselves, the family, nurses and physicians. Vascular surgeons may do their best to reconstruct the blood supply. Orthopedic surgeons may take effort to salvage as neat as possible.
Stem cell bioengineering can be applied for tissue and vessel regeneration after the debridement, with a nice scientific team work consist of bioengineers, cell scientists, immunologists, bioconduct companies, pharmacists, physical therapists, experts for regenerative medicine etc. Mesenchymal derived stem cells (MDSC) and adipocytes derived stem cells (ADMS) can be autologous or endogenous. Endogenous stem cells and tissue-engineered implant can be applied with immunopression with scalable tech using biconstruct transplantation. Exosome from stem cells culture media is found rich in MALAT1 that is essential for wound healing. Local injection of neural growth factor (NGF), TPO, soluble stem cell recruitment factors (SDF-1), inflammation-modulators, progenitors, nitrate oxide (NO), hypoxia indicible factor (HIF-1a) can promote the growth of vessels, angiogenesis, and the regeneration of the tissues. Local light energy can also be used for better outcome.
No man can move the mountain along. With neater team healthcare, not only it will benefit diabetic foot, but wound care and regenerative medicine of any kind.