中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (31): 5845-5848.doi: 10.3969/j.issn.1673-8225.2010.31.036

• 器官移植临床实践 clinical practice of organ transplantation • 上一篇    下一篇

自体游离皮片移植在糖尿病足溃疡治疗中的应用

吴志远，梁  杰，郭晓瑞，黄海华，郝新光   

  1. 广东医学院附属医院整形外科，广东省湛江市  524001
  • 出版日期:2010-07-30 发布日期:2010-07-30
  • 通讯作者: 郭晓瑞，硕士，广东医学院附属医院整形外科，广东省湛江市 524001
  • 作者简介:吴志远★，男，1970年生，广东省湛江市人，汉族，2001年广东医学院毕业，硕士，副主任医师，主要从事难愈性创面及糖尿病足的基础和临床研究。 Wuzhiyuan1388@yahoo.com.cn

Application of autologous free skin graft in treatment of diabetic foot ulcer

Wu Zhi-yuan, Liang Jie, Guo Xiao-rui, Huang Hai-hua, Hao Xin-guang   

  1. Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical College, Zhanjiang   524001, Guangdong Province, China
  • Online:2010-07-30 Published:2010-07-30
  • Contact: Guo Xiao-rui, Master, Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical College, Zhanjiang 524001, Guangdong Province, China
  • About author:Wu Zhi-yuan★, Master, Associate chief physician, Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical College, Zhanjiang 524001, Guangdong Province, China Wuzhiyuan1388@yahoo.com.cn

PDF

523

被引次数

20

摘要：

背景：临床工作中发现无论是采用轴型皮瓣还是随意皮瓣修复糖尿病足病都难以保持良好的血供，皮瓣存活困难，且供瓣处又形成一个新的创面，难以愈合。如行局部皮瓣转移容易造成皮瓣血供不好，引起皮瓣坏死。
目的：探讨自体游离皮片移植在治疗糖尿病足溃疡病中的临床作用。
方法：选择糖尿病足溃疡患者102例，其中男57例，女45例；年龄54.5(35~83)岁。糖尿病史3个月~23年，平均12年；糖尿病足坏疽病程20 d~2.5年，平均7个月。经全身抗炎、降糖治疗及创面处理，溃疡创面为肉芽覆盖时，视创面部位、大小等用滚轴式取皮刀在自体供皮区取刃厚或薄中厚皮片后采用打包法植皮或邮票状植皮，用无菌棉垫加压包扎，石膏托固定患肢，保证移植皮片与肉芽创面紧密接触。
结果与结论：102例患者均行一期局部清创、二期植皮，植皮区未发生严重感染或因创面生长不良而形成新的溃疡。其中83例植皮后全部皮片成活，创面愈合出院。19例植皮创面少量皮片未成活，经换药或补植后迅速控制，创面愈合出院，平均历时(21±7)d。院外获随访89例，随访时间3个月~3.5年，平均15个月。3例原位溃疡复发，5例其他部位新发溃疡，余患者病足均能自行或借助拐杖条件下满足站立、行走等功能要求。说明自体游离皮片移植是治疗糖尿病足溃疡的有效方法。

关键词: 糖尿病, 糖尿病足, 溃疡, 游离皮片, 组织移植

Abstract:

BACKGROUND: In the clinic, it was found that the flap survived difficultly after the diabetic foot using skin flap, whether random-pattern flap or axial pattern skin flaps are difficult to maintain a good blood supply. And it is difficult to heal where the flap for the formation to be a new wound. Transfer of local skin flap can induce poor blood supply and flap necrosis.
OBJECTIVE: To explore clinical effects of autologous free skin graft transplantation in treatment of diabetic foot ulcer.
METHODS: A total of 102 patients (57 males and 45 females) with diabetic foot ulcer were treated, with an average age of 54.5 years (35-83 years). The disease course of diabetes was 3 months to 23 years (12 years on average) and the disease course of diabetic foot was 20 days to 2.5 years (7 months on average). Before skin grafting, the patients were treated with general treatment, including insulin, antibiotics. Serial wound surface managements were achieved. When new layers of granulation tissues were formed over the wounds, the split skin grafts were transplanted. According to wound location, size, with the humby knife or drum dermatome to take skin from autologous donor site to graft skin with packaging method or stamp-like skin grafting. Affected limb was fixed using plaster slab. And pressure bandage with sterile pad to be ensure skin graft in close contact with the granulation wound.
RESULTS AND CONCLUSION: 102 patients carried out the first partial debridement, later-stage used skin grafting. None of skin graft area formed a new ulcer because of severe wound infection or the undesirable growth. Of them, 83 cases of skin grafts survived well after the skin graft, and following wound healing they was discharged. 19 cases of skin graft survival were poor, and controlled through the dressing or replanted quickly, and then discharged, with a mean process of (21±7) days. A total of 89 cases were followed up for 15 months averagely (ranged from 3 months to 3.5 years). Eight patients developed new ulcers, with 3 lesions in situ and 5 lesions in new site. Other patients can stand or walk by themselves or with a cane. These indicated that autologous free skin graft is an effective method in treating diabetic foot ulcer.

中图分类号: