糖尿病足部溃疡创面皮瓣移植方式选择及效果对比

Selection and effect comparison of skin flap transplantation on diabetic foot ulcer wound

目的观察糖尿病足部溃疡(DFU)创面皮瓣移植方式选择和效果。方法河北省唐山市第二医院DFU患者195例,根据皮瓣移植方式分为三组各65例。A组予小腿部位带蒂皮瓣治疗;B组予局部转移皮瓣合并或未合并手术治疗;C组予游离股前外侧皮瓣治疗。比较三组疗效、足部溃疡愈合基本情况、治疗前后创面生长细胞因子血管内皮生长因子(VEGF)、碱性成纤维生长因子(bFGF)、转化生长因子-β1(TGF-β1),随访12个月,统计三组手术次数、溃疡复发率、截肢率。结果A组总有效率高于B、C组,疼痛缓解时间、住院时间、肢端感觉恢复时间、溃疡创面愈合时间及肉芽组织形成时间短于B、C组(P<0.05)。治疗4、12周后,三组创面VEGF、bFGF、TGF-β1水平较治疗前、治疗后2周升高,且A组高于B、C组(P<0.05)。随访12个月,A组手术次数少于B、C组,溃疡复发率、截肢率低于B、C组(P<0.05)。结论与局部转移皮瓣合并或未合并手术、游离股前外侧皮瓣比较,小腿部位带蒂皮瓣效果显著,更能促进DFU患者创面生长细胞分泌,进一步加快足部溃疡愈合,降低截肢率。

Objective To investigate the selection and effect comparison of skin flap transplantation on diabetic foot ulcer(DFU)wound.Methods A total of 195 patients with DFU from Tangshan Second Hospital of Hebei Province were divided into group A,B and C according to the method of skin flap transplantation,65 in each group.The group A was treated with pedicled leg flap.The group B was treated with local flap with or without surgical treatment.The group C was treated with free anterolateral thigh flap.The curative effect,basic situation of foot ulcer healing,wound growth cytokine such as vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF)and transforming growth factor-β1(TGF-β1)before and after treatment were compared among the three groups.The follow-up period was 12 months.The operative times,ulcer recurrence rate and amputation rate of the three groups were statistically analyzed.Results The total effective rate of the group A was higher than that of groups B and C(P<0.05).The time of pain relief,hospitalization,recovery of limb sensation,healing time of ulcer wounds and granulation tissue formation in the group A were shorter than those in groups B and C(P<0.05).After 4 and 12 weeks of treatment,the levels of VEGF,bFGF,and TGF-β1 in the wounds of the 3 groups were higher than those before and 2 weeks after treatment,and the levels of the group A were higher than those of the groups B and C(P<0.05).After 12 months of follow-up,the number of operations in the group A was less than that in groups B and C and the ulcer recurrence rate and amputation rate were lower than those in groups B and C(P<0.05).Conclusion Compared with locally transferred skin flaps with or without surgery and free anterolateral thigh flaps,the pedicled skin flaps on the calf has a more significant effect.It can promote the secretion of growth cells in the wound of DFU,further accelerate the healing of foot ulcers and reduce the rate of amputation.