糖尿病性皮肤溃疡创面的修复

目的　探讨促进糖尿病性皮肤溃疡创面愈合、缩短病程和降低致残率的好方法。方法　对 6 8例糖尿病性皮肤溃疡患者采用控制血糖、增加营养、防治感染等措施 ,以稳定病情为基础 ,以创面局部清创、改善局部血运和外用药物换药培育肉芽生长为条件 ,以整形手术为手段的方法治疗。结果　病情平稳 ,所有创面均顺利修复 ,创面愈合时间平均 2 8天 ,无截肢现象。平均随访时间 1年 ,随访率 86 .7% ,疗效满意率 81.4 % ,出现溃疡复发或新的皮肤溃疡者占 18.6 %。结论　多科室合作在全身治疗稳定病情的基础上 ,积极行创面局部处理和手术治疗是促进糖尿病性皮肤溃疡创面早期修复、缩短病程和降低致残率切实可行的方法 ,并要重视患者溃疡愈合出院后的指导工作     

糖尿病性皮肤溃疡创面的修复

目的探讨促进糖尿病性皮肤溃疡创面愈合、缩短病程和降低致残率的好方法.方法对68例糖尿病性皮肤溃疡患者采用控制血糖、增加营养、防治感染等措施,以稳定病情为基础,以创面局部清创、改善局部血运和外用药物换药培育肉芽生长为条件,以整形手术为手段的方法治疗.结果病情平稳,所有创面均顺利修复,创面愈合时间平均28天,无截肢现象.平均随访时间1年,随访率86.7%,疗效满意率81.4%,出现溃疡复发或新的皮肤溃疡者占18.6%.结论多科室合作在全身治疗稳定病情的基础上,积极行创面局部处理和手术治疗是促进糖尿病性皮肤溃疡创面早期修复、缩短病程和降低致残率切实可行的方法,并要重视患者溃疡愈合出院后的指导工作.     

糖尿病性皮肤溃疡创面的修复

目的 探讨促进糖尿病性皮肤溃疡创面愈合、缩短病程和降低致残率的好方法。方法 对68例糖尿病性皮肤溃疡患者采用控制血糖、增加营养、防治感染等措施，以稳定病情为基础，以创面局部清创、改善局部血运和外用药物换药培育肉芽生长为条件，以整形手术为手段的方法治疗。结果 病情平稳，所有创面均顺利修复，创面愈合时间平均28天，无截肢现象。平均随访时间1年，随访率86．7％，疗效满意率81．4％，出现溃疡复发或新的皮肤溃疡者占18．6％。结论 多科室合作在全身治疗稳定病情的基础上，积极行创面局部处理和手术治疗是促进糖尿病性皮肤溃疡创面早期修复、缩短病程和降低致残率切实可行的方法，并要重视患者溃疡愈合出院后的指导工作。     

氢溴酸山莨菪碱外敷治疗糖尿病足溃疡

目的：研究氢溴酸山莨菪碱外敷治疗糖尿病足溃疡的疗效。方法：在控制血糖抗感染等综合治疗的基础上,将80例糖尿病足患者随机分为3组,A组30例采用氢溴酸山莨菪碱湿敷创面,B组30例采用表皮生长因子外喷创面,C组20例常规治疗。结果：A组、B组肉芽开始出现时间及溃疡愈合时间相近,且均快于C组。结论：氢溴酸山莨菪碱可促进糖尿病足部溃疡的愈合,提高溃疡的治愈率,疗效与表皮生长因子相近。     

封闭式负压引流联合点状植皮在糖尿病足溃疡治疗中的临床应用

目的探讨封闭式负压引流联合点状植皮治疗人糖尿病足溃疡的疗效。方法将20例Wagner分级2~4级的糖尿病足溃疡患者分成对照组和观察组,每组10例,对照组溃疡创面持续应用封闭式负压引流,观察组溃疡创面应用封闭式负压引流联合点状植皮治疗。比较两组患者创面愈合率及创面愈合时间。结果观察组与对照组相比,创面愈合率明显增加(98.39%±1.61%vs 78.80%±1.85%)、创面愈合时间明显缩短(56.40±5.33天vs 74.70±8.55天),两组比较差异具有统计学意义。结论封闭式负压引流联合点状植皮可以促进糖尿病足溃疡创面愈合,缩短愈合时间,降低了截肢率。     

不同部位糖尿病足溃疡愈合情况分析

目的了解不同部位糖尿病足溃疡愈合情况。方法采用前瞻性研究方法,对142例Wagner分级2~4级的糖尿病足溃疡患者采取多学科协作的综合治疗方法,收集入院首次临床检查资料,留取入院每次清创后足溃疡照片,比较治疗30d内不同部位的足溃疡创面缩小率。结果发生在足背、足踝、足弓、足趾、足前掌及足跟的Wagner分级为2级的溃疡创面缩小率比较,差异有统计学意义(P0.01),发生在足趾的糖尿病足溃疡创面缩小率最小,足踝部及足背部溃疡创面缩小率较大。Wagner分级为2、3级的非受压组溃疡创面缩小率显著大于受压组(均P0.01)。结论不同部位糖尿病足溃疡愈合存在差异,治疗糖尿病足过程中采取适当的减压措施有利于糖尿病足溃疡的愈合。     

封闭负压引流技术在糖尿病足治疗中的应用体会

糖尿病足是糖尿病患者由于神经病变及各种不同程度末梢血管病变而导致的下肢感染、溃疡形成和/或深部组织的破坏.糖尿病足治疗难度大、时间长,如不能及时控制感染修复创面,有截肢的风险,严重影响患者的生存质量.我科在积极治疗原发病基础上,采用封闭负压引流技术(vacuum ealing drainage,VSD),积极有效地控制糖尿病足创面感染的发展,促进创面新鲜肉芽组织的生长,运用植皮和局部皮瓣转移,修复破溃创面,有效地降低了致残率.     

异种脱细胞真皮治疗2型糖尿病足溃疡效果观察

目的探讨异种脱细胞真皮治疗糖尿病足溃疡的效果。方法将92例糖尿病足溃疡患者随机分为两组各46例,均进行全身基础治疗,待局部伤口床准备充分,伤口进入重塑期后对照组使用湿性敷料换药;观察组使用异种脱细胞真皮基质覆盖创面,外敷碳敷料加压包扎换药。8周后评价效果。结果观察组溃疡面积缩小率及疼痛评分显著优于对照组;观察组愈合天数较短、创面感染发生率较低且治疗花费较少,与对照组比较,差异有统计学意义(均P 0. 01)。结论异种脱细胞真皮基质能够促进糖尿病足溃疡创面愈合,缩短愈合天数及减轻患者换药疼痛。     

二肽基肽酶4抑制剂对糖尿病足溃疡愈合影响的研究进展北大核心CSCD

目的综述二肽基肽酶4(dipeptidyl peptidase 4,DPP-4)抑制剂对糖尿病足溃疡愈合的影响及其机制研究进展。方法查阅近年来关于DPP-4抑制剂治疗糖尿病足溃疡的相关文献,并进行总结分析。结果 DPP-4抑制剂能促进溃疡创面愈合,其可能作用机制包括:抑制创面基质金属蛋白酶的表达,恢复创面基质金属蛋白酶及其抑制剂的平衡;促进内皮祖细胞的募集以及血管新生;调节由于慢性创面所致的免疫反应及优化细胞外基质构建。目前,临床研究结果显示,DPP-4抑制剂可作为一种促进糖尿病足溃疡愈合的辅助治疗手段。结论 DPP-4抑制剂具有促进糖尿病足溃疡愈合的作用,但仍需大样本、多中心随机对照试验以及长期随访进一步验证其疗效及安全性。     

二肽基肽酶4抑制剂对糖尿病足溃疡愈合影响的研究进展

目的综述二肽基肽酶4(dipeptidyl peptidase 4,DPP-4)抑制剂对糖尿病足溃疡愈合的影响及其机制研究进展。方法查阅近年来关于DPP-4抑制剂治疗糖尿病足溃疡的相关文献,并进行总结分析。结果 DPP-4抑制剂能促进溃疡创面愈合,其可能作用机制包括:抑制创面基质金属蛋白酶的表达,恢复创面基质金属蛋白酶及其抑制剂的平衡;促进内皮祖细胞的募集以及血管新生;调节由于慢性创面所致的免疫反应及优化细胞外基质构建。目前,临床研究结果显示,DPP-4抑制剂可作为一种促进糖尿病足溃疡愈合的辅助治疗手段。结论 DPP-4抑制剂具有促进糖尿病足溃疡愈合的作用,但仍需大样本、多中心随机对照试验以及长期随访进一步验证其疗效及安全性。     

Ulcer‐free survival days and ulcer healing in patients with diabetic foot ulcers: A prospective cohort study

Healing rates may not give a complete indication of the effectiveness and management of diabetic foot ulcers because of high recurrence rates. The most important outcome for patients is remaining ulcer‐free; however, this has hardly been investigated. The aim of our study was to prospectively investigate ulcer‐free survival days and ulcer healing in patients with diabetic foot ulcers. This was a prospective cohort study of all referrals to our diabetic foot expertise centre from December 2014 to April 2017. Outcomes were determined after a minimum follow‐up period of 12 months. Primary outcomes were ulcer‐free survival days and 12‐month healing percentages. Predictors for ulcer‐free survival days and healing were investigated in multivariate analyses. A total of 158 patients were included. Median ulcer‐free survival days in the healed group were 233 days (interquartile range [IQR] 121‐312) and 131 days (IQR 0–298) in the overall population. The healing rate at 12‐month follow up was 67% (106/158), and the recurrence rate was 31% (33/106). Independent predictors of ulcer‐free survival days were duration of diabetes, peripheral artery disease (PAD), cardiovascular disease, end‐stage renal disease (ESRD), and infection. Ulcer‐free survival days are related to PAD and cardiovascular disease, and ulcer‐free survival days should be the main outcome when comparing the effectiveness of management and prevention of the diabetic foot ulcers.     

Recurrence rate of diabetic neurotrophic foot ulcers healed using topical application of growth factors released from platelets

The purpose of this study was to determine the recurrence rate of diabetic neurotrophic foot ulcers that had healed in a treatment protocol using topically applied growth factors released from platelets. Thirty-six patients with diabetic neurotrophic foot ulcers were entered into a randomized prospective double-blind 20-week trial of topically applied platelet growth factors or buffered saline dressings. Ulcers had been present for 15.5 months (mean, range 2 to 60 months). Sixteen patients (44%) healed and were followed up for as many as 30 months to determine the rate of ulcer recurrence. Eleven patients (68.8%) had ulcers that recurred, including 10 treated with platelet growth factors and one treated with buffered saline solution. These ulcers had been present for 20 months (range 5 to 60 months) before healing. Average time to ulcer recurrence was 2.2 months (range 0.25 to 7 months). Five ulcers (31.2%) remained healed, including four treated with platelet growth factors and one treated with buffered saline solution. These healed, nonrecurring ulcers had been present for 5 months (range 2 to 6 months) before healing. Average follow up was 25 months (range 24 to 30 months). Ulcers were more likely to recur if they had been present longer before healing. If patients were not compliant in wearing footwear to protect the healed ulcer, the ulcers were prone to early recurrence. These data indicate that ulcers healed by using growth factors in the form of a platelet growth factors did not have more durable skin over the ulcer and were prone to early ulcer recurrence.     

糖尿病足的外科一站式治疗

目的 探讨糖尿病足外科一站式治疗的临床价值.方法 175例(206条肢体)糖尿病足患者,根据患肢的不同情况,灵活组合应用球囊扩张和(或)支架成形术、局部清创术、持续负压引流术、特殊敷料换药、人工血管旁路术、自体静脉旁路术、杂交手术、截肢(趾)术、单纯保守治疗等各种治疗措施.结果 腔内治疗和旁路术治疗的糖尿病足患者术后1...     

Determinants of Success After Metatarsal Head Resection for the Treatment of Neuropathic Diabetic Foot Ulcers

Metatarsal head resection (MHR) is an effective option for the treatment of nonhealing neuropathic diabetic foot ulcers. The present study aimed to identify factors that predict treatment success for neuropathic diabetic foot ulcers undergoing metatarsal head resection. In this prospective interventional case series, 30 consecutive diabetic patients with documented nonischemic neuropathic plantar diabetic foot ulcers beneath the metatarsal head who underwent MHR were included. The study endpoint was demographic indicators of early and late postoperative outcomes. Patients were followed up for 1 to 66 months (mean 37.6 months). Except for 1 patient, all subjects’ wounds (96.6%) healed after metatarsal head resection within an average of 35 days. One of the operated patients (3.4%) suffered short-term complications; long-term complications occurred in 23.3% of the patients. One patient (3.4%) experienced ulcer recurrence, 3 patients (10%) developed wound infection, and transfer lesions occurred in 3 other patients (10%) during the follow-up period. Using 3 estimators including ordinary least squares (OLS), White's heteroscedastic standard errors, and bootstrapping procedure, we could not find any statistically significant demographic feature related to ulcer healing. Using regression modeling, we could not find any evidence for a role of age, sex, weight, height, BMI, duration of ulcer until MHR, and duration of diabetes mellitus (years since diabetes diagnosis) affecting the outcome of MHR. Hence, demographic features, duration of ulcer until MHR, and years with diabetes did not affect the outcome of MHR. In conclusion, the authors believe that MHR will have a high rate of success for neuropathic wound healing in this specific subset of patients regardless of demographic features, as long as there is no ischemia to impair healing by secondary intention.     

The diabetic foot seen by the surgeon. Personal experience

BACKGROUND: The aim of this study is to evaluate a major amputation risk criterion in diabetic patients with trophic lesions of the foot. The records of a series of 100 consecutive patients (65 males and 35 females) with diabetic foot ulcer treated in our surgical facilities between January 1992 and December 1997, in collaboration with diabetologists and podiatrists, have been reviewed retrospectively. METHODS: In 26 cases the ulcer involved both limbs and, therefore, the feet observed in this study have been 126. Accurate diagnosis of the underlying cause was the first step and in cases with a poor blood supply (69 limbs; 55%) unresponsive to medical therapy (44 limbs) vascular reconstruction (37 limbs), spinal cord stimulator (SCS) implantation (3 limbs) or major amputation (4 limbs) were performed. According to Wagner grading there were 42 grade 2 ulcers (33%), 38 grade 3 (30%), 43 grade 4 (34%) ad 3 grade 5 (3%). RESULTS: One patient died postoperatively after SCS implantation. All but 4 neuropathic ulcers (53 limbs) healed in a mean time (+/- SD) of 5.2 +/- 3.8 months and all but 10 vascular ulcers (59 limbs) healed in a mean time of 6.3 +/- 4.1 months. Of the latter group in 4 cases the patient died before ulcer healing while in 6 cases (8.7%) a major amputation was performed (in 2 cases after vascular reconstruction procedures). Minor amputations of the forefoot have been performed in 23 instances (33%) of vascular ulcer and in 10 cases (17%) of neuropathic ulcer. CONCLUSIONS: Since ischemia is the main risk factor for amputation, it is suggested that a particular effort should be made in improving the vascular diagnostic, both clinical and strumental, capabilities of our diabetologists and podiatrists in order to detect the vascular insufficiency in earlier stages.     

Reliability of free-flap coverage in diabetic foot ulcers

As microsurgery advances, microsurgical free-tissue transfers have become the reconstructive method of choice over staged or primary amputation, and enabling independent ambulation in difficult lower-extremity wounds. In this report, we present our experiences with free-tissue transfer for the reconstruction of soft-tissue defects in 13 diabetic foot ulcers. Following radical debridement, soft-tissue reconstruction was achieved in the following ways: anterolateral thigh fasciocutaneous flap in 5 patients, radial forearm fasciocutaneous flap in 3 patients, lateral arm fasciocutaneous flap in 1 patient, gracilis musculocutaneous flap in 1 patient, tensor fascia latae flap in 1 patient, deep inferior epigastric perforator flap in 1 patient, and a parascapular flap in the remaining patient. In 8 cases, diabetic wounds were in the foot, while wounds were at the level of the lower leg in the remaining patients. In all patients, vascular patency was confirmed by the Doppler technique. In suspicious cases, arteriography was then performed. While all flaps survived well in the postoperative period, one patient died from cardiopulmonary problems on postoperative day 16 in an intensive care unit. Amputation was necessary in the early postoperative period because of healing problems. In the remaining 10 cases, all flaps survived intact. In one case, arterial revision was performed successfully. The ultimate limb salvage rate was 83% for the 12 patients. Independent ambulation was achieved in these cases. During the follow-up period of 8 months to 2 years, no ulcer recurrence was noted, and no revascularization or vascular bypass surgery was needed before or after the free-tissue transfers. The authors conclude that free-tissue transfer for diabetic foot ulcers is a reliable procedure, despite pessimistic opinions regarding the flap survival and low limb salvage rates. It should be considered a useful reconstructive option for serious defects in well-selected cases.     

Total-contact casting as an adjunct to promote healing of pressure ulcers in amputees

Partial foot amputations have become increasingly prevalent among long-lived diabetic patients. These patients have lower extremity neuropathy and are prone to ulceration at their amputation site. These ulcers are difficult to heal, and they place a significant financial and resource burden on the healthcare system. We examined the efficacy of total-contact casts (TCC) in diabetic amputees with nonhealing partial foot amputation site neuropathic ulcers. Data were collected retrospectively on all patients with amputations who were treated with a total-contact cast between December 2000 and December 2003. Seventeen patients (13 men, 4 women) with amputation site ulceration were identified. All patients were diagnosed with neuropathy secondary to diabetes and none had wound healing compromised by ischemia. The initial ulcer averaged 1,169 mm(2) with a depth of 2.77 mm. Patients were treated with an average of 7.9 cast applications over 8.4 weeks; 47% (8/17) of ulcers healed, but 29% (5/17) of patients were unable to complete their recommended treatment course secondary to complications from the TCC. Of the patients who were able to complete their treatment course, the healing rate was 66.7% (8/12). The recurrence rate for healed ulcers was 63% (5/8). Partial foot amputations with neuropathic ulcers present a very difficult problem to the vascular surgeon. Patient compliance and underlying medical comorbidities limit the success rate. In patients who can complete a TCC treatment course, good short term results can be expected. However, recurrence rates are high following discontinuation of mechanical TCC off-loading.     

Comparison of Metatarsal Head Resection Versus Conservative Care in Treatment of Neuropathic Diabetic Foot Ulcers

Complications from diabetic foot ulcers often lead to increased patient morbidity. Much debate still ensues concerning surgical versus conservative management of neuropathic diabetic foot ulcerations. The present study assessed and compared the efficacy of metatarsal head resection and medical approach in the treatment of neuropathic diabetic foot ulcers located at the plantar surface of metatarsal heads. In a retrospective cohort study, 24 consecutive neuropathic diabetic foot ulcers in the lower area of the metatarsal heads that had undergone metatarsal head resection were included as the operative group. For the control group, we included 25 similar ulcers that were scheduled for medical therapy. With respect to postoperative complications, wound healing occurred earlier in the operative group, and the recurrence rate was inversely greater in the medical treatment group. Also, the hospitalization rate was significantly greater in the medical treatment group. Overall, the long-term complication rate was lower in the operative than in the medical treatment group. Also, the infection rate was greater in the medical treatment group than in the operative group. Comparing early and late clinical outcomes of metatarsal head resection surgery and medical treatment showed complete superiority for the surgical approach, and metatarsal head resection is more completely cost beneficial than the medical approach.     

Prevalence of foot ulcers in dialysis‐dependent patients

Hemodialysis patients are at high risk for foot ulceration. The aim of this prospective study was to describe the prevalence and risk factors for foot ulcers in hemodialysis‐dependent patients. From 2012 until 2015, all hemodialysis patients (n = 66) above18 years of age, treated at the Alrijne Hospital (Leiderdorp, the Netherlands), were included. Demographics and medical history were collected and the quality of life was measured. Data were collected on common risk factors for foot ulceration: peripheral arterial disease, peripheral neuropathy with or without foot deformities, diabetes mellitus (DM), hypertension, smoking, previous foot ulcer, edema, pedicure attendance, and orthopedic footwear. Sixty‐six hemodialysis patients were evaluated; the prevalence of foot ulcer was 21/66 (31.8%). Risk factors were history of foot ulceration in 27/66 (40.9%), ankle‐brachial index (ABI) <0.9, and toe pressure < 80 mmHg in 38/66 (57.6%). The percentage of DM in the group of foot‐ulcers was higher 13/21 (61.9%) vs. 20/45 (44.4%) in the non‐ulcer group, this was not significant (p = 0.183). No differences were found in ABI, toe pressure, peripheral neuropathy and foot deformity, between the DM and non DM group. The mortality between ulcer vs. no ulcer was significant different: 13/21 (61.9%) vs. 11/45 (24.4%) (p = 0.003). Approximately, one‐third of hemodialysis patient have a foot ulcer 21/66 (32%). Arterial insufficiency is associated with an increased risk of foot ulcers. In patients with a foot ulcer, survival is significantly lower than in patients without a foot ulcer; interventions to reduce foot ulceration should be implemented for all hemodialysis patients and include frequent inspection, and prompt treatment. Further research should focus on the prevention of foot ulcers in dialysis‐dependent patients.     

Treatment of diabetic foot complications with hyperbaric oxygen therapy: A retrospective experience

BackgroundThe aim of this study is to evaluate the role of hyperbaric oxygen in the treatment of diabetic foot ulcers.MethodsWe performed a retrospective observational study of all patients with diabetic foot ulcers treated at the Institution's hyperbaric chamber between January 2010 and August 2012. Patient data was obtained upon patient hospital visit and prospective clinical record consultation.ResultsTwenty-six foot lesions including 13 foot ulcers Wagner grade 2 or greater and 13 amputation stump ulcers were submitted to hyperbaric oxygen therapy between January 2010 and August 2012 in our Institution. Of these, 23 foot lesions completed treatment and complete epithelialization of the primary lesion was achieved in 15 (65%). The mean healing period since the first hyperbaric oxygen therapy session was 16 weeks. Above-ankle amputations were performed in 3 limbs and transmetatarsal amputations in 2 limbs.ConclusionHyperbaric oxygen may be associated with ulcer healing in selected diabetic foot ulcers with impaired cicatrization.