改良VSD技术联合网状中厚皮片移植在糖尿病足难治性溃疡患者中的应用

Application of modified VSD technique combined with medium-thickness mesh skin graft in patients with refractory diabetic foot ulcer

目的观察改良负压封闭引流(VSD)技术联合网状中厚皮片移植在糖尿病足难治性溃疡患者中的临床应用效果。方法选择2018年1月至2020年5月江门市中心医院烧伤整形科收治的40例糖尿病难治性溃疡患者作为研究对象,按照随机数表法将其分为观察组和对照组各20例。对照组患者采用常规中厚皮片移植治疗,观察组患者采用改良VSD技术联合网状中厚皮片移植治疗。比较两组患者的皮片存活率、术后换药次数、创面愈合时间及住院时间;比较两组患者治疗后2周、4周和8周的溃疡面积缩小率和肉芽组织覆盖率;治疗后3个月、6个月,采用数字评价量表(NRS)和温哥华癜痕评分量表(VSS)评价两组患者的疼痛程度和癜痕情况;治疗6个月后比较两组患者的不良事件发生情况。结果观察组患者的皮片存活率为(92.23±6.23)%,明显高于对照组的(79.26±5.46)%,术后换药次数、创面愈合时间及住院时间分别为(3.31±0.46)次、(10.23±1.33)d和(12.84±2.26)d,明显少(短)于对照组的(4.29±0.67)次、(12.56±1.68)d、(15.03±2.91)d,差异均有统计学意义(P<0.05);观察组患者治疗后2周、4周和8周的溃疡面积缩小率、肉芽组织覆盖率明显大于同期对照组,差异均有统计学意义(P<0.05);观察组患者治疗后3个月、6个月的NRS评分、VSS评分分别为(1.23±0.32)分、(0.94±0.19)分和(3.39±0.63)分、(2.03±0.36)分,明显低于同期对照组的(1.66±0.41)分、(1.21±0.29)分和(5.22±0.86)分、(3.45±0.64)分,差异均有统计学意义(P<0.05);观察组患者的不良事件发生率为5.0%,明显低于对照组30.0%,差异有统计学意义(P<0.05)。结论改良VSD技术联合网状中厚皮片移植能够及时清除糖尿病足难治性溃疡患者的创面渗出物,促进了新鲜肉芽组织生长和创面愈合速度,皮瓣存活率显著提升,值得在临床上推广应用。

Objective To observe the application of modified VSD technique combined with mesh medium thickness skin graft in patients with refractory ulcer of diabetic foot.Methods From January 2018 to May 2020,40 patients with refractory diabetic ulcer in our hospital were selected as the research objects.According to random number table method,they were divided into an observation group(20 cases)and a control group(20 cases).The control group was treated with conventional medium-thickness skin graft,and the observation group was treated with modified vacuum sealing drainage(VSD)technology combined with mesh medium-thickness skin graft.The survival rate of skin flap,the frequency of dressing change,wound healing time,and length of hospital stay in the two groups were analyzed and compared.The ulcer area reduction rate and granulation tissue coverage rate of the two groups were compared at 2 weeks,4 weeks and 8 weeks after treatment.The patients in the two groups were evaluated and compared in pain degree and vitiligo condition at 3 months and 6 months after treatment by Numerical Rating Scale(NRS)and Vancouver Scar Scale(VSS).After 6 months of treatment,the incidence of adverse events was compared between the two groups.Results The flap survival rate of the observation group was(92.23±6.23)%,which was significantly higher than(79.26±5.46)%in the control group;the times of dressing change,wound healing time,and length of hospital stay in the observation group were(3.31±0.46)times,(10.23±1.33)d,and(12.84±2.26)d,respectively,which were significantly lower than(4.29±0.67)times,(12.56±1.68)d,(15.03±2.91)d of the control group(P<0.05);the ulcer area reduction rate and granulation tissue coverage rate of the observation group at 2 weeks,4 weeks,and 8 weeks after treatment were significantly higher than those of the control group(P<0.05);the NRS score and VSS score of the observation group at 3 months and 6 months after treatment were(1.23±0.32)points,(0.94±0.19)points and(3.39±0.63)points,(2.03±0.36)points,which were significantly lower than(1.66±0.41)points,(1.21±0.29)points and(5.22±0.86)points,(3.45±0.64)points of the control group at the same period(P<0.05);the incidence of adverse events in the observation group was 5.0%,which was significantly lower than 30.0%in the control group(P<0.05).Conclusion The improved VSD technology combined with reticular medium thickness skin graft can timely remove the wound exudates of patients with refractory ulcer of diabetic foot,promote the growth of fresh granulation tissue and wound healing speed,and significantly improve the survival rate of skin flap,which is worthy of clinical application.