Chronology and Determinants of Tissue Repair in Diabetic Lower-Extremity Ulcers
Chronology and Determinants of Tissue Repair in Diabetic Lower-Extremity Ulcers
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DOI：
10.2337/diab.40.10.1305
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发表时间：
1991-10
期刊：
影响因子：
7.7
通讯作者：
R. Pecoraro;J. H. Ahroni;E. Boyko;V. Stensel
中科院分区：
文献类型：
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作者：
R. Pecoraro;J. H. Ahroni;E. Boyko;V. Stensel
尽管我们对正常皮肤愈合的细胞生理学的了解最近取得了进展，但组织修复的自然历史和糖尿病溃疡愈合不良的关键决定因素仍然不清楚。为了描述时间顺序并确定影响愈合的重要因素，我们采用客观方法来量化 46 名按照标准化临床方案接受局部伤口护理的糖尿病门诊患者全层下肢溃疡的伤口愈合率。最初的溃疡愈合率、最终的组织修复状态和最终的临床结果与年龄没有显着相关；糖尿病类型、持续时间或治疗；糖化血红蛋白的水平或变化；目前吸烟；存在感觉神经病变；溃疡位置或类别；初次感染；或反复感染的频率。然而，通过伤口周围经皮氧张力（TcPo2）和经皮二氧化碳张力（TcPco2）测量来估计局部皮肤灌注的直接测量，与组织修复的初始率显着相关（分别为P = 0.003和0.005）。尽管最终的溃疡再上皮化与足部血压和伤口周围 TcPo2 和 TcPco2 显着相关，但局部皮肤灌注这些参数对早期愈合的强烈预测与足背节段多普勒动脉血压的影响无关。我们得出结论，伤口周围皮肤灌注是糖尿病溃疡愈合的关键生理决定因素，表明当平均伤口周围 TcPo2 <20 mmHg 时，早期愈合失败的风险增加 39 倍。
The natural history of tissue repair and the critical determinants of faulty healing of diabetic ulcers remain obscure despite recent advances in our knowledge of the cellular physiology of normal cutaneous healing. To characterize the chronology and identify important factors affecting healing, we applied an objective method to quantify the rate of wound healing of full-thickness lower-extremity ulcers in 46 diabetic outpatients who received local wound care under a standardized clinical protocol. The initial ulcer healing rate, eventual status of tissue repair, and definitive clinical outcome were not significantly associated with age; diabetes type, duration, or treatment; level or change in glycosylated hemoglobin; current smoking; presence of sensory neuropathy; ulcer location or class; initial infection; or frequency of recurrent infections. However, direct measures of local cutaneous perfusion, estimated by periwound measurements of transcutaneous O2 tension (TcPo2) and transcutaneous CO2 tension (TcPco2), were significantly associated with the initial rate of tissue repair (P = 0.003 and 0.005, respectively). The strong prediction of early healing by these parameters of local skin perfusion was independent from the effects of segmental Doppler arterial blood pressure at the dorsalis pedis, although eventual ulcer reepithelialization was significantly related to foot blood pressure and periwound TcPo2 and TcPco2. We conclude that periwound cutaneous perfusion is the critical physiological determinant of diabetic ulcer healing, indicating a 39-fold increased risk of early healing failure when the average periwound TcPo2 is <20 mmHg.