How to Treat Diabetic Foot with Blocked Blood Vessels and Ischemic Necrosis?
Yesterday, our specialized diabetic foot clinic admitted another patient suffering from severe ischemic necrosis—a common yet dangerous complication of diabetes. The local hospital had recommended immediate amputation, but the patient chose to seek limb-preserving treatment at our center and is currently undergoing comprehensive care.
Understanding Ischemic Necrosis in Diabetic Patients
Ischemic necrosis, particularly in individuals with long-standing diabetes, often results from peripheral arterial disease (PAD), where plaque buildup due to atherosclerosis narrows or blocks blood flow in the lower limbs. As these plaques grow or trigger blood clots, circulation slows significantly, reducing oxygen and nutrient delivery to the extremities. This leads to chronic or acute limb ischemia, characterized by symptoms such as numbness, dry skin, muscle weakness, persistent pain, intermittent claudication (pain while walking), rest pain, and eventually dry gangrene.
Current Medical Interventions: Benefits and Risks
The most widely used approach for restoring blood flow is endovascular intervention. This minimally invasive technique involves inserting catheters and guidewires through a small puncture site to dilate the narrowed artery using balloons, sometimes placing stents to keep the vessel open. While this method can rapidly improve circulation and relieve symptoms in the short term, it comes with notable limitations.
Potential complications include dislodged plaque fragments that may cause sudden blockages in other arteries—leading to heart attack, stroke, or acute limb ischemia. Additionally, restenosis (re-narrowing of the artery) occurs frequently, often requiring repeated procedures. Not all patients are suitable candidates due to calcified vessels or extensive disease, making long-term success uncertain.
Tibial Bone Transport Surgery: An Alternative Approach
Another surgical option gaining attention is tibial distraction osteogenesis, also known as bone transport surgery. This orthopedic procedure leverages the body's natural healing process—the formation of new capillary networks within regenerating bone callus. These newly formed microvessels enhance local blood perfusion, potentially improving tissue viability in ischemic limbs.
However, despite its theoretical benefits, this technique carries significant risks. Documented complications include delayed or non-union of bone, soft tissue infections, pin-site infections, limb deformities (such as foot drop or leg shortening), chronic pain, and even permanent disability. Recovery time is lengthy, and close monitoring is essential throughout the treatment period.
The Limitations of Conventional Therapies
While both endovascular and surgical methods focus primarily on revascularization, they often fall short in addressing one critical aspect: wound management. Many clinicians prioritize reopening blocked arteries but overlook systematic care of the existing ulcers or necrotic tissue. Without proper wound debridement, infection control, and biological support for tissue regeneration, even successfully revascularized limbs may continue to deteriorate.
This gap in treatment highlights a crucial need for an integrated, multidisciplinary strategy—one that doesn't just restore blood flow but also actively promotes healing at the tissue level.
A Comprehensive Solution: Integrated Chinese and Western Medicine
An increasingly effective alternative is the integration of traditional Chinese medicine (TCM) with modern Western medical practices. This holistic model addresses two core issues simultaneously: peripheral vascular disease and chronic wound healing. Rather than treating them separately, this combined approach recognizes their interdependence—improved circulation supports faster wound repair, while optimized wound care reduces systemic inflammation and enhances overall outcomes.
How Combined Therapy Works
The treatment protocol typically includes:
- Vasodilating medications and herbal formulas to improve microcirculation and reduce blood viscosity.
- Debridement techniques, including autolytic, enzymatic, and surgical methods, to remove dead tissue and prevent infection.
- Topical TCM preparations that promote granulation tissue growth and reduce exudate.
- Hyperbaric oxygen therapy (HBOT) and negative pressure wound therapy (NPWT) when indicated.
- Nutritional support and glycemic control tailored to each patient's condition.
This system not only enhances blood supply to the affected limb but also creates an optimal environment for natural tissue regeneration—potentially avoiding amputation in many cases.
Why Specialized Care Matters
Given the complexity of diabetic foot syndrome, treatment should never be approached casually. Patients are strongly advised to seek care at dedicated diabetic foot centers staffed by interdisciplinary teams—including endocrinologists, vascular surgeons, podiatrists, wound care specialists, and integrative medicine practitioners.
Early intervention, accurate diagnosis, and personalized treatment planning are key to preserving limb function and improving quality of life. With the right combination of science-backed therapies and holistic support, many patients can achieve full recovery without resorting to major surgery.
If you or a loved one is facing diabetic foot complications with poor circulation, don't lose hope. Explore advanced conservative options before making irreversible decisions like amputation. The future of limb salvage lies in comprehensive, patient-centered care that treats both the cause and the consequence of vascular damage.