负压封闭引流技术联合植皮治疗糖尿病足30例

Vacuum sealing drainage combined with skin grafting in the treatment of 30 cases of diabetic foot

目的总结负压封闭引流(VSD)技术联合植皮治疗糖尿病足的经验。方法回顾性分析辽宁中医药大学附属医院血管疮疡外科2016年8月至2017年8月期间收治的30例糖尿病足患者的临床资料,均为Wagner分级4~5级的患者,处理方法主要包括清创、VSD技术、植皮等。观察住院时间、肢体功能及外形、植皮区瘢痕挛缩情况。出院后电话及门诊随访30例患者,随访时间3~12个月,平均5个月,观察肢体外形、功能、溃疡复发情况。结果 3例患者足部存在缺血,计算机体层血管成像(CTA)提示下肢动脉存在闭塞情况,行股浅动脉开通、球囊扩张、支架成形术,术后行清创、经VSD治疗后行植皮治疗,创面完全愈合。23例患者经清创后,行VSD技术治疗后,创面见新鲜肉芽组织生长,植皮后创面完全愈合。另4例患者由于创面感染严重,清创后组织缺损较多,间断行清创、VSD技术治疗后,肉芽组织填充生长良好,行植皮手术治疗,移植皮片大部分成活。所有糖尿病足创面均治愈,住院时间27~50 d,平均35 d; 27例皮片颜色良好,具有良好弹性,足部运动功能恢复良好; 3例因植皮处为足底或足前端摩擦后出现小溃疡,经门诊换药1周左右后均愈合,随访期间,未见复发。结论在清创的基础上,后期行VSD技术联合植皮治疗糖尿病足,能够缩短病程。

Objective To summarize the experience of vacuum sealing drainage (VSD) combined with skin grafting in the treatment of diabetic foot.MethodsThe clinical data of 30 patients with diabetic foot admitted from August 2016 to August 2017 in the Department of Vascular Ulcer Surgery, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine were retrospectively analyzed. All patients were of Wagner grade 4 to 5. The treatment methods included debridement, VSD and skin grafting. The length of hospital stay, limb function and appearance, and scar contracture in the skin graft area were observed. After discharge, 30 patients were followed up by telephone and outpatient clinic for 3 to 12 months, with an average of 5 months. Limb appearance, function and ulcer recurrenceobservation were observed.ResultsThree patients had ischemia of the foot, CT angiography (CTA) showed occlusion of the lower extremity arteries. Superficial femoral artery was opened, balloon dilatation and stenting were performed. After debridement, skin grafting was performed after VSD, and the wound healed completely. After debridement and VSD treatment of 23 patients, fresh granulation tissue grew and the wound healed completely after skin grafting. In the other 4 cases, due to serious wound infection, there were more tissue defects after debridement. After intermittent debridement and VSD treatment, the granulation tissue grew well and most of the grafts survived after skin grafting. All diabetic foot wounds were cured with an average hospitalization time of 35 days (27 to 50 days);27 cases had good skin color, good elasticity and good recovery of foot movement function;3 case had small ulcers due to friction at the plantar or foot front, which were changed dressing for about a week after outpatient treatment. All patients healed without recurrenc during follow-up period.ConclusionOn the basis of debridement, VSD combined with skin grafting can shorten the course of disease and improve the limb salvage rate.