抗生素骨水泥联合螺旋桨皮瓣在修复糖尿病足踝部创面中的应用

Application of antibiotic cement combined with propeller flap in the repair of diabetic foot and ankle wound

目的探讨抗生素骨水泥联合螺旋桨皮瓣在修复糖尿病足踝部创面中的临床应用价值。方法回顾性分析2013年9月—2015年12月,应用万古霉素或妥布霉素骨水泥联合腓动脉穿支或胫后动脉穿支螺旋桨皮瓣修复糖尿病足踝部创面9例。其中男性6例,女性3例;年龄45~63岁,平均53.1岁。致伤原因:道路交通伤5例,重物压砸伤2例,机器伤1例,摔伤1例。其中7例伤口分泌物细菌培养为阳性,创面缺损范围:4.5cm×4.0cm^8.0cm×6.5cm。术前将患者血糖控制在空腹<7mmol/L,餐后2h<11mmol/L,使用足量敏感抗生素抗感染,待创面周围水肿基本消退,用手持多普勒超声进行穿支点定位并完成螺旋桨皮瓣设计。术中对创面进行彻底清创,按术前设计切取皮瓣,皮瓣旋转修复创面,在皮瓣下方感染严重的区域放置抗生素骨水泥条1~2根,术后2~3周拔出。皮瓣切取范围13.0cm×5.0cm^23.0cm×9.0cm,4例供区直接缝合,5例供区植皮修复。结果术中顺利完成皮瓣切取及创面修复,术后皮瓣均顺利成活,其中2例皮瓣远端部分坏死,经换药后愈合,供区切口Ⅰ期愈合。患者均获随访,随访时间6~21个月,平均11.1个月,所有皮瓣外形良好。结论抗生素骨水泥联合螺旋桨皮瓣是修复糖尿病足踝部创面的有效方法。

ObjectiveTo investigate the clinical application value of antibiotic cement combined with propeller flap in the repair of diabetic foot and ankle wounds.MethodsFrom Sep.2013to Dec.2015,9diabetic patients with foot and ankle wounds who were treated by vancomycin cement or tobramycin cement combined with peroneal artery perforator or posterior tibial artery propeller flap were reviewed retrospectively.There were6males and3females,with an average age of531years(range,45to63years).The causes included traffic accident injury in5cases,heavy crush injury in2cases,machine injury in1case and falling injury in1case.Among all the cases,the wound secretion bacterial culture was positive in7cases,and the defect area ranged from45cm×40cm to80cm×65cm.Before operation,the blood sugar was controlled within7mmol/L when limosis,and within11mmol/L at two hours after meal.A sufficient amount of sensitive antibiotics was used to prevent infection.After peripheral edema dissipating,hand held Doppler ultrasound was used to locate the perforators and complete propeller flap design.Through debridement during the operation,preoperative design guided the flap harvest and flap rotation repaired the wound.In the serious infection areas under the flap,12vancomycin cement bars were placed,and pulled out after23weeks.The size of flaps varied from130cm×50cm to230cm×90cm.The donor sites in4cases were directly sutured,and the donor sites of5cases were repaired by skin graft.ResultsDuring the operation,the flaps were successfully harvested and the wounds were repaired.All flaps survived smoothly,among which2cases had distal flap necrosis but healed after changing dressing.The donor sites were healed by first intention.All cases were followed up from6months to21months(mean,111months).All flaps had good shape.ConclusionAntibiotic cement combined with propeller flap is an effective way in the repair of diabetic foot and ankle wounds.