不同真皮替代材料联合封闭负压引流技术修复糖尿病患者肌腱外露创面的效果

Effect of different dermal substitute materials combined with vacuum sealing drainage technique on repair of tendon-exposed wound in diabetic patients

目的探讨真皮替代材料联合负压引流技术修复糖尿病患者肌腱外露创面的效果。方法收集在安阳市人民医院住院的应用脱细胞真皮基质(acellular dermal matrix,ADM)治疗肌腱外露糖尿病患者8例的临床资料为ADM组,以及同期郑州大学第一附属医院收治的应用人工真皮(artificial dermis,AD)治疗糖尿病肌腱外露患者12例的临床资料为AD组。创面清创后用AD或ADM覆盖外露肌腱,二期行自体刃厚皮移植,配合应用封闭负压引流技术。观察两组的植皮次数、移植间隔时间、植皮后7 d皮片成活情况、住院费用、术后并发症发生率、随访3个月时术区再发破溃情况。结果两组植皮次数、皮片成活率、术后并发症及术后随访情况比较差异无统计学意义(P>0.05),ADM组平均移植间隔时间则少于AD组,平均住院费用高于AD组(P<0.05)。结论真皮替代材料联合封闭负压引流技术为修复糖尿病肌腱外露创面提供了一种有效途径,ADM和AD各有优劣,临床应根据实际情况选择。

Objective To investigate the effect of dermal substitute materials combined with vacuum sealing drainage(VSD)technique on the repair of tendon-exposed wound in patients with diabetes mellitus(DM).Methods The clinical data of 8 DM patients with tendon-exposed wound that were treated with acellular dermal matrix(ADM)in People′s Hospital of Anyang City were collected and they were enrolled as ADM group.The clinical data of 12 DM patients with tendon-exposed wound treated with artificial dermis(AD)in the First Affiliated Hospital of Zhengzhou University for the treatment of tendon-exposed wound were collected and they were enrolled as AD group.After wound debridement,the exposed tendon was covered with AD or ADM,and the second stage of autologous blade thickness skin graft was performed,combined with the application of closed negative pressure drainage technology.The times of skin grafting,the interval of transplantation,the survival of skin graft at 7 d after skin grafting,hospitalization cost,the incidence of postoperative complications and the recurrence of ulceration in the operation area at 3 months of follow-up were observed.Results There was no significant difference in the number of skin grafting,survival rate of skin graft,postoperative complications and postoperative follow-up between two groups(P>0.05).The average transplantation interval in ADM group was less than that in AD group,and the average hospitalization cost was higher than that in AD group(P<0.05).Conclusion Dermal substitute materials combined with vacuum sealing drainage technique is an effective avenue to repair the wounds of tendon-exposed wound.ADM and AD have their own advantages and disadvantages,which should be selected according to the actual condition.