2014+美国糖尿病足溃疡管理指南.pdfVIP

ORIGINAL ARTICLES The Management of Diabetic Foot Ulcers Through Optimal Off-Loading Building Consensus Guidelines and Practical Recommendations to Improve Outcomes Robert J. Snyder, DPM, MSc* Robert G. Frykberg, DPM, MPH?? Lee C. Rogers, DPM§ Andrew J. Applewhite, MDjj Desmond Bell, DPM?#** Gregory Bohn, MD?? Caroline E. Fife, MD??§§ Jeffrey Jensen, DPM* James Wilcox, RNjjjj Background: We sought to develop a consensus statement for the use of off-loading in the management of diabetic foot ulcers (DFUs). Methods: A literature search of PubMed for evidence regarding off-loading of DFUs was initially conducted, followed by a meeting of authors on March 15, 2013, in Philadelphia, Pennsylvania, to draft consensus statements and recommendations using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach to assess quality of evidence and develop strength of recommendations for each consensus statement. Results: Evidence is clear that adequate off-loading increases the likelihood of DFU healing and that increased clinician use of effective off-loading is necessary. Recommendations are included to guide clinicians on the optimal use of off-loading based on an initial comprehensive patient/wound assessment and the necessity to improve patient adherence with off-loading devices. Conclusions: The likelihood of DFU healing is increased with off-loading adherence, and, current evidence favors the use of nonremovable casts or fixed ankle walking braces as optimum off-loading modalities. There currently exists a gap between what the evidence supports regarding the efficacy of DFU off-loading and what is performed in clinical practice despite expert consensus on the standard of care. (J Am Podiatr Med Assoc 104(6): 555-567, 2014) *Barry University School of Podiatric Medicine, Miami Shores, FL. ?Carl T. Hayden Veteran Affairs Medical Center, Phoenix, AZ. ?Midwestern University School of Podiatric Medicine, Glendale, AZ. §Amputation Prevention Cent