Vacuum sealing drainage technique versus traditional repair in treatment of diabetic foot

doi:10.3969/j.issn.2095-4344.2014.34.024

Abstract

Abstract:

BACKGROUND: Studies have shown that the vacuum sealing drainage technology can effectively promote the wound healing, and it has a wide prospect of clinical application, but there are few reports addressing the treatment of diabetic foot.

OBJECTIVE: To discuss the clinical effect of vacuum sealing drainage technology in the treatment of diabetic foot wounds.

METHODS: Sixty diabetic foot patients were randomly divided into two groups: traditional treatment group, regulating blood sugar level, dressing and traditional debridement; vacuum sealing drainage group, conventional treatment combined with the vacuum sealing drainage technology. The clinical efficacy of two treatments for diabetic foot was evaluated.

RESULTS AND CONCLUSION: Compared with the traditional treatment group, the vacuum sealing drainage showed better outcomes in switching frequency, stable blood sugar control, preparation time, wound healing time and cure rate (P < 0.05). It indicates that the vacuum sealing drainage technology in the treatment of diabetic foot ulcers can resolute wound inflammation, stimulate the growth of granulation, create a favorable surgical condition for secondary skin grafting or flap coverage, significantly shorten the treatment time, and exhibit better curative effects than the traditional treatment.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

全文链接：

Key words: diabetic foot, drainage, granulation tissue, surgical flaps

CLC Number:

R318

Zhu Xin-hua, Chai Yi-min, Ye Ji-zhong, Han Pei, Wen Gen, Chen Pei. Vacuum sealing drainage technique versus traditional repair in treatment of diabetic foot[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(34): 5548-5554.

Figures/Tables 5

2.1 受试者数量分析患者60例均进入结果分析，无中途退出，无脱失值。 2.2 受试者基线资料比较两组患者的性别、年龄、患病时间、溃疡面积等一般资料比较差异均无显著性意义(P > 0.05)，具有可比性，见表1。 2.3 传统治疗、负压封闭引流技术治疗糖尿病足的病程转归对比与传统治疗组相比，负压封闭引流治疗组病程总的换药次数、干预后血糖控制平稳时间、创面二期修复准备时间、创面愈合时间、治愈率及复发率均有明显改善(P < 0.05)，见表2。传统治疗组病程转归：传统组的30例患者，6例患者因创面感染难以控制最后选择修复截肢或残端修整，24例患者愈合。其中，5例面积较小的患者(20-30 cm2)换药愈合：在清创后，采取隔天换药，经过三四周治疗后，换药15-20次后，创面瘢痕愈合。有16例患者(30-50 cm2)植皮治疗：经过两三次清创后，通过植皮覆盖创面，干预后移植皮肤均存活，但边缘愈合缓慢，7-10 d换药后，创面愈合，总换药次数20-30次。3例皮瓣修复：患者因创面深及肌腱骨质，污染严重，面积大(>50 cm2)，反复多次清创后(≥3次)，创面或残端行皮瓣覆盖修复，干预后均出现不同程度皮瓣感染坏死，均住院超过4月，总换药次数都达60多次。传统治疗组，治疗时间46-145 d，平均61 d；因创面换药次数增多，病患创面疼痛，易造成感染，干预后血糖趋于平稳时间较长。随访6-10个月，有4例患者植皮创面难以经受摩擦，在原来感染坏死残端有复发破溃表现，门诊换药迁延不愈，需再次住院治疗。负压封闭引流治疗组病程转归：负压封闭引流治疗组的30例患者中，7例创面(20-30 cm2)换药愈合：在一次负压封闭引流引流后，创面明显缩小，住院约2周，隔天换药5-10次后愈合(图1)。21例创面(30-50 cm2)通过负压封闭引流+植皮修复治愈：其中15例经一次封闭式负压引流后，肉芽组织生长好，植皮修复存活(图2)，病程换药10-20次；其中4例由于创面感染严重，待2次负压封闭引流引流治疗后，肉芽组织生长满意，二期植皮成活(图3)，病程换药15-20次；其中2例感染较重的创面，重复负压封闭引流引流3次后，植皮愈合，病程换药20余次。2例患者通过皮瓣修复修复：骨质肌腱外露，创面面积大(> 50 cm2)，在使用负压封闭引流技术治疗后，二期行肢体皮瓣转移覆盖，1例愈合，干预后3周拆线，病程42 d，换药20次，随访效果好(图4)。有1例干预后皮瓣远端感染坏死，二期清创皮瓣修整缝合，病程68 d，换药32次。负压封闭引流治疗组，治疗时间23-45 d，平均30 d；因负压封闭引流技术更好的控制感染，减少换药次数，减轻病患痛苦，血糖调控平稳时间明显缩短。干预后随访6-10个月，植皮创面及转移皮瓣血运良好，具有良好弹性，穿鞋或安装假肢后，肢体耐摩擦，运动功能恢复良好。有2例患者在原创面处，出现复发破溃表现，门诊换药后，均愈合。"

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