脱细胞真皮基质结合自体皮移植治疗糖尿病足创面

Clinical study on treatment of diabetic foot wounds with acellular dermal matrix combined with autologous skin transplantation

目的使用脱细胞真皮基质结合自体皮移植和单纯自体皮移植对糖尿病足患者进行创面修复治疗,并探讨其临床疗效。方法选择2018年1月至2019年11月在华中科技大学同济医学院附属梨园医院创面修复科住院的糖尿病足患者10例,按照住院号码单双号分为两组,分别为单号实验组与双号对照组,对照组创面给予自体皮移植,实验组创面给予脱细胞真皮基质结合自体皮移植。比较两组基本特征,创面面积、创面愈合时间、供皮区与受皮区整体愈合时间等。部分病例门诊随访时行皮肤超声或愈合创面取组织行病理检查。结果实验组创面面积(32.20±19.75)cm^2,对照组创面面积(39.70±17.92)cm^2,两组创面面积差异无统计学意义(t=-0.629,P>0.05),实验组创面愈合时间(42.80±8.44)d,对照组创面愈合时间(27.60±6.88)d,对照组创面愈合时间少于实验组,差异有统计学意义(t=3.122,P<0.05),但供皮区与受皮区整体愈合时间,实验组为(42.80±8.44)d,对照组为(34.60±6.47)d,两组比较差异无统计学意义(t=1.725,P>0.05),且实验组病例皮肤超声及组织病理检查均可见真皮结构。结论脱细胞真皮基质结合自体皮移植能有效的促进创面愈合,是治疗糖尿病足重建真皮结构的一种有效方法,同时避免其他部位的二次损伤。

Objective To use acellular dermal matrix combined with autologous skin transplantation and pure autogenous skin transplantation to repair wounds in patients with diabetic foot,and to explore its clinical efficacy.Methods From January 2018 to November 2019,10 diabetic foot patients who were hospitalized in the Wound Repair Department of Liyuan Hospital,Tongji Medical College,Huazhong University of Science and Technology were selected and divided into two groups according to the hospitalization number.The experimental group was given acellular dermal matrix combined with autologous skin transplantation to repair the wounds,and the control group was given pure autologous skin transplantation to repair the wounds.The basic characteristics,wound area,wound healing time,the overall healing time of the donor area and the skin area were compared.In the follow-up of some cases,skin ultrasound was done or wound healing tissues were taken for pathological examination.Results The wound area in the experimental group and control group was(32.20±19.75)cm^2and(39.70±17.92)cm^2respectively.There was no significant difference in wound area between the two groups(t=-0.629,P>0.05).The wound healing time in the experimental group and control group was(42.80±8.44)days and(27.60±6.88)days respectively with the difference being statistically significant(t=3.122,P<0.05).The overall healing time of the donor area and the recipient area in the experimental group and control group was(42.80±8.44)days and(34.60±6.47)daysrespectively with the difference being not statistically significant between two groups(t=1.725,P>0.05).The dermal structure could be seen on the skin ultrasound and histopathological examination in the experimental group.Conclusion Acellular dermal matrix combined with autologous skin transplantation can effectively promote wound healing.It is an effective method for the reconstruction of dermal structure in diabetic feet and avoids secondary injury in other parts.