人工真皮联合负压封闭引流技术修复糖尿病足跟部骨外露15例

Artificial dermis combined with vacuum sealing drainage to repair 15 cases of diabetic heel bone exposure

目的探讨人工真皮联合负压封闭引流技术对糖尿病足跟部骨外露修复的临床疗效。方法选择2012年8月至2017年8月于本院接受治疗的15例糖尿病足跟部骨外露患者为研究对象,常规手术清创后持续负压封闭引流,待肉芽组织生长良好后行人工真皮胶原支架结合自体皮片移植,观察手术时间、住院时间、术后创面愈合率、术后创面愈合时间、术后创面外观进行统计。分别于术后1个月、3个月、6个月、12个月对患者进行随访并进行优劣效评价,计算有效率。结果 15例均获得定期随访,随访12个月。所有病例跟部骨外露创面完全愈合,手术时间(67.3±14.1) min、平均住院时间(32.4±14.6) d、术后创面愈合时间(21.3±7.6) d,创面外观良好,行走无疼痛。1例植皮后皮肤部分边缘坏死,经换药1个月愈合。人工真皮修复的骨外露创面全部愈合,未发生创口感染、创口出血、神经损伤、过敏反应等并发症及不良反应;术后随访骨外露创面均完全愈合,无疤痕及形态异常,皮肤弹性及耐磨性良好,无反差色改变,无再发皮肤破损,能满足负重功能需求。结论负压封闭引流术后,人工真皮通过胶原支架诱导创面形成类真皮组织覆盖骨外露创面,促进肉芽组织增生,具有手术操作简单,创面柔韧性、耐磨性好,复发率低,疗效满意,是修复糖尿病足跟部骨外露的理想方法。

Objective To investigate the clinical effect of artificial dermis combined with vacuum sealing drainage on repairing bone exposure of diabetic foot. Methods To choose between August 2012 and August 2017 in our hospital for treatment of 15 diabetic foot patients with bone exposure as the research object. The wound was combined with routine surgical debridement, and continuous vacuum sealing drainage, and granulation tissue grew well, artificial dermal coverage combined with autologous skin transplantation were used to observe the operation time, hospitalized time, postoperative wound healing rate, wound healing time and wound appearance for statistical analysis. Patients were followed up at 1 month, 3 months, 6 months and 12 months after the operation, and the advantages and disadvantages were evaluated, and the effective rate was calculated. Results In the study, all 15 cases were followed up regularly for 12 months, the all wounds with exposed calcaneal bone healed completely.The wound healing time was (67.3±14.1) min, the average hospitalization time was (32.4±14.6) d, and the postoperative wound healing time was (21.3±7.6) d. The wound appearance was good and there was no pain in walking. After skin grafting, partial skin necrosis was observed in 1 case, which healed after 1 month of dressing change. All patients were followed up regularly for 12 months. All the exposed wounds of bone and tendon repaired by artificial dermis were healed without complications and adverse reactions such as wound infection, wound hemorrhage, nerve injury and allergic reaction, etc. All wounds with bone exposure healed completely after follow-up, with no scars and morphological abnormalities, good skin elasticity and abrasion resistance, no change in contrast color, and no recurrence of skin damage, which can meet the requirements of weight-bearing function. Conclusion After vacuum sealing drainage, artificial dermis can induce the formation of dermoid tissue covering the exposed bone and fascia through collagen scaffold, promote the proliferation of granulation tissue, complete removal of lesions, simple operation, good wound flexibility, abrasion resistance, low recurrence rate and satisfactory curative effect, which is an ideal method for repairing the soft tissue defect of diabetic foot.