[Clinical effects of combined application of skin-stretching device and vacuum sealing drainage in repairing the diabetic foot wounds].
[Clinical effects of combined application of skin-stretching device and vacuum sealing drainage in repairing the diabetic foot wounds].
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DOI：
10.3760/cma.j.cn501120-20200621-00318
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发表时间：
2020-11-20
影响因子：
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通讯作者：
Tao, K
中科院分区：
文献类型：
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作者：
Ji, P;Zhang, Y;Tao, K
目的：探讨皮肤牵张器（以下简称牵张器）联合负压封闭引流（VSD）修复糖尿病足创面的临床效果。方法：2016年3月至2020年1月，空军军医大学第一附属医院收治25例糖尿病足创面患者，其中男18例，女7例，年龄40～70岁。清创后行间歇性VSD 3～10天，负压值为-10.67 kPa。此时创面面积为5.0 cm×3.0 cm至10.0 cm×7.0 cm。感染控制及消肿后，使用牵张器治疗创面3～5天。牵张后的创面面积为5.0 cm×0.3 cm至10.0 cm×0.5 cm。采用全层缝合关闭创面。缝合术后2周观察患者足部创面愈合等级，并在随访期间观察溃疡创面复发、足部坏疽等严重并发症以及创面瘢痕情况。结果：缝合术后2周，23例患者创面甲级愈合。2例患者在牵张期间软组织感染溃疡复发，经抗感染、彻底清创及VSD治疗后，再行牵张治疗16天创面愈合。在3～36个月的随访期间，23例患者牵张创面遗留线性瘢痕，皮肤弹性、色泽、感觉与周围正常组织相似，肢体活动良好，2例患者瘢痕增生明显。1例患者在随访10个月时糖尿病足复发，患侧肢体血管严重闭塞并坏疽，行小腿截肢治疗。结论：牵张器联合VSD治疗糖尿病足创面可避免供区损伤，愈合后的创面外观与邻近皮肤相似，修复效果满意。
Objective: To investigate the clinical effects of skin-stretching device (hereinafter referred to as stretcher) combined with vacuum sealing drainage (VSD) in repairing diabetic foot wounds. Methods: From March 2016 to January 2020, 25 patients with diabetic foot wounds were admitted to the First Affiliated Hospital of Air Force Medical University, including 18 males and 7 females, with age of 40 to 70 years. After debridement, intermittent VSD was performed for 3 to 10 days, with negative pressure value of -10.67 kPa. Then, the wound area was 5.0 cm*3.0 cm to 10.0 cm*7.0 cm. After infection control and detumescence, the wound was treated with stretcher for 3 to 5 days. The wound area after stretching ranged from 5.0 cm*0.3 cm to 10.0 cm*0.5 cm. The wound was closed with full-thickness suture. Two weeks after the suturing operation, the healing grade of the foot wound of patients was observed, and the serious complications such as recurrence of ulcer wound and gangrene on the foot, scar condition of the wound were observed during follow-up. Results: Two weeks after the suturing operation, the wounds of 23 patients were healed with grade A. Soft tissue infection ulcer relapsed in 2 patients during the stretch period. After anti-infection, thorough debridement, and VSD, the wounds were healed after another 16 days of stretch treatment. During the follow-up of 3 to 36 months, 23 patients had linear scar left on the stretch wounds, and the skin elasticity, color, sensation was similar to the surrounding normal tissue, and the limb mobility was good, and 2 patients had obvious scar hyperplasia. One patient had recurrence of diabetic foot and serious vascular occlusion and gangrene in the affected limb at follow-up of 10 months, which was treated with amputation of the lower leg. Conclusions: The use of stretcher combined with VSD in treating diabetic foot wound can avoid donor site injury, with healed wound achieving similar appearance to adjacent skin and satisfactory repair effects.