糖尿病足溃疡外科处理体会及病例报告

Treatment of diabetic foot in surgical ways:report of 4 patients

目的通过对糖尿病足溃疡外科处理的4个典型病例的总结,分析探讨外科处理的应用条件及具体方式。方法分析总结解放军306医院全军糖尿病诊治中心于2007年3月至2007年12月收治的4例糖尿病足溃疡典型病例的临床资料。结果第1例经积极内科综合治疗,全身情况改善的同时给予分步去痂、加强换药得到治愈。第2、3例经局部彻底清创、抗感染治疗痊愈。第4例经彻底清创、创面床准备后给与局部皮瓣及植皮治疗痊愈。结论综合内科治疗对于积极外科干预很重要;糖尿病足溃疡创面深部实际情况比外观情况严重,窦道造影等进一步检查可能有助于真正了解病情;经过创面床准备,择期进行植皮、皮瓣转移等创面覆盖手术,会缩短愈合时间;进行糖尿病足溃疡创面处理时要注意把握"整体观念"、"标本观念",还要注意下肢血管情况的评估和改善;清创时要把握"去骨留皮,抽筋存肌,最大限度保功能"的原则;创面处理要根据患者全身情况酌情采用不同方式进行。

Objective Todiscuss the surgical treatment of diabetic foot ulcer by summarizing 4 diabetic foot ulcer cases treated in surgical ways. Methods The data of 4 diabetic foot cases who were treated from March to December 2007 in the PLA Diabetes Center of the PLA 306 Hospital were analyzed. Results The first case was cured by removing scab step by step and exchanging dress properly, and at the same time, his basic conditions having been immproved. The second and third patients＇ wound got healed by local complete debridement and antibacterial treatment. The fourth case＇ recovery got from local flat shift and derma transplant operation, after his wound bed got best prepared. Conclusions Integrated medical treatments were as important as active surgical treatments ;Some diabteic foot ulcers were more serious in fact than what were seen from outside, imaging through wound canal is a helpful way to know the exact condition of these cases; Derma transplation or flats shift and such kinds of cover-wound surgeries can shorten the recovery time; It was important to hold the two ideas in caring diabetic foot cases, the one was looking the body as a whole, and the other was knowing something major, something second; The evaluation and improvement of blood vessel in lower limbs should be paid great attention; When debridement was administered, necrotic bones and tendons should be removed drastically, dermas and muscles should be saved as possible as we can, and the most important thing was to reserve the function of the foot ; Wounds of diabetic foot should be treated in different ways according to the patients＇basic conditions.