应用超显微外科技术修复糖尿病足溃疡的临床疗效

Clinical outcome of treatment of diabetic foot ulcers using supermicrosurgery technique

目的探讨超显微外科技术修复糖尿病足溃疡的临床疗效。方法选取2015-01至2016-12收治的糖尿病足溃疡患者35例,均采用超显微外科技术进行溃疡修复,平均年龄52.4岁,平均随访时间为18.1个月。结合超声多普勒检查和清创肉眼观察,在溃疡周围选择充盈良好、口径在0.8 mm以内的穿支动脉或小动脉作为皮瓣受体血管,行穿支皮瓣吻合。术后采用皮瓣存活率和保肢率评定患者的临床疗效。结果在随访期内,30例皮瓣存活良好,皮瓣存活率85.7%。5例出现皮瓣局部坏死,其中2例经清创和植皮后溃疡二期愈合,剩余3例溃疡不愈合甚至进一步扩大,予以截肢,保肢率为91.4%。术后SAS、SDS评分较术前显著降低,BI指数较术前显著上升,差异均有统计学意义(P<0.05)。结论相比经典皮瓣手术,利用超显微外科技术对糖尿病足溃疡修复重建是安全有效的,且供区损伤更小,恢复更快。该技术关键在于选择合适的受体血管。

Objective To evaluate the clinical outcome of diabetic foot reconstruction with supermicrosurgery techniques.Methods Thirty-five cases of diabetic foot reconstruction using supermicrosurgery techniques between January 2015 and December2016 were reviewed. The average age of patients was 52. 4 years and average follow-up was 18. 1 months. Preoperative Doppler examination and visual inspection during the debridement were conducted to choose the adequate recipient artery. Reconstruction was performed with perforator flaps using the supermicrosurgery approach. The clinical outcome was evaluated with the flap survival rate and limb salvage rate. Results Among the 35 cases,there were five cases of flap loss,so the flap survival rate was 85. 7 percent. Among the five cases of flap loss,two patients achieved secondary healing after debridement and skin grafting,and the rest were eventually amputated and the overall limb salvage rate was 91. 4 percent. The SAS score and SDS score of all the patients decreased significantly after operation,while the BI index increased significantly（ P〈0. 05）. Conclusions Compared with classic skin flap surgery,the supermicrosurgery approach to diabetic foot wound repair is effective. The area damage is smaller and the recovery is faster. The key to this technique is to select appropriate receptor vessels.