I期转移皮瓣修复肿瘤切除后创面46例

我院肿瘤科自1997年4月～2001年5月采用转移皮瓣一期修复肿瘤切除后创面46例 ,将原来需二期手术的病例于第一次手术切除肿瘤时同台完成 ,其中包括皮肤癌16例 ,恶性黑色素瘤7例 ,晚期乳癌2例 ,克服了传统术式的不足 ,临床上取得了较为满意的效果 ,现报道分析如下 :1资料与方法46例肿瘤患者中 ,良性肿瘤21例 ,恶性肿瘤25例 ,男31例 ,女15例 ,中位年龄41岁。根据肿瘤部位切除后采用不同的转移皮瓣修复 ,体表良性肿瘤多采用推移皮瓣及旋转皮瓣 ,面积不大可采用随意皮瓣 ,不一定需要含血管蒂 ,具有方便灵活的优点。若缺损面积大 ,随意皮瓣不易成…     

带腓浅神经外踝上皮瓣修复糖尿病足创面的临床体会

目的探讨带腓浅神经外踝上皮瓣修复糖尿病足创面的临床疗效。方法本院收治的糖尿病足并溃疡创面患者52例,随机分为观察组和对照组各26例。观察组患者均给予带腓浅神经外踝上皮瓣修复术治疗,对照组患者均给予传统的保守治疗。结果观察组26例患者移植皮瓣血供情况均良好,皮瓣均成活,创面均达到甲级愈合,随访12个月,患者的踝关节功能良好,患者行走正常,22例患者足背外侧有轻微麻木感。对照组26例患者中,12例患者创面愈合,14例保守治疗失败,最终选择手术进行治疗后创面愈合,术后3例患者的踝关节功能不佳。观察组患者的创面愈合情况以及踝关节功能恢复情况均明显优于对照组患者（P〈0.05）。结论带腓浅神经外踝上皮瓣修复糖尿病足创面可以有效地修复创面、促进创面的愈合,还可以部分恢复患者的修复处感觉,值得临床推广。     

皮瓣在深度创面修复中的应用

目的　探讨各种深度创面修复的方法。方法　 6 8例各种创伤所致的 72处深度创面 ,利用邻位皮瓣 4 0个 ,带蒂皮瓣 2 3个 ,岛状皮瓣 4个 ,肌皮瓣 2个 ,游离皮瓣 3个 ,在早期扩创 ,清除坏死组织后一期修复创面。结果　 72个皮瓣中除 1个游离皮瓣远端皮缘部分坏死外 ,余皮瓣全部成活。结论　皮瓣是一期修复各种深度创面有效方法之一。     

改良菱形皮瓣修复创面的临床应用

目的应用改良菱形皮瓣修复创面的效果观察。方法采用改良菱形皮瓣对58例圆形或椭圆形的创面进行修复,利用创面邻近处的皮肤,采用旋转和推进相结合的方法直接覆盖创面。结果58例均得到一期修复,所修复创面的皮肤颜色和质地基本与周边皮肤色泽一样。供瓣区术后疤痕不明显,不需要植皮。结论认为采取改良菱形皮瓣对修复一定范围内的创面是一种简单易行方法。     

局部转移皮瓣修复面部皮肤缺损创面42例

圆形创面修复是耳鼻咽喉科门诊手术中常见问题。1985年以来我们应用NOTE皮瓣(“音符式”皮瓣)修复因耳前瘘管、面部体表肿瘤等切除后的圆形创面42例,现报告如下。     

带蒂筋膜皮瓣修复四肢难治性创面

目的应用多种类型带蒂筋膜皮瓣，使四肢创面能有一种比较简单、安全、有效的治疗方法。方法根据创面特点及所在部位不同，采用Z成形、双侧反向Z成形、顺形或逆行移位，交臂或交腿等方法形成筋膜皮瓣，修复四肢难治性创面。结果本组25例，移植皮瓣成活率近100％全部创面被修复。结论应用带蒂筋膜皮瓣修复四肢有深部组织裸露创面，方法比较简单安全，能有效解决一般方法难以修复的创面。     

真皮下血管网皮瓣在深度烧伤创面修复中的应用

我院烧伤科1991年以来应用含真皮下血管网薄皮瓣,修复前臂、腕、手、足等部位深度烧伤创面16例,效果满意,现报告如下。临床资料16例中男11例,女5例,年龄15～50岁。手术时间为伤后24小时～45天。应用额部薄皮瓣修复鼻部电烧伤1例;胸部薄皮瓣修复颈部硫酸烧伤1例,手指电烧伤4例;腹部薄皮瓣修复手背、腕部烧伤7例;大腿内侧、小腿内侧中下部及小腿薄皮瓣修复会阴部、膝关节、内踝部烧伤3例。本组各创面分别有肌胆、骨胳、关节囊、神经等组织外露,其中6例创面术前有感染,创面最大面积22cm×9cm,最小面积3.scm×2．5Cm.手术方法：（1…     

关于轴型皮瓣在骨关节外露创面的应用

自1991年7月以来，笔者对34例患者的41处骨关节外露创面应用轴型皮瓣进行修复，其中3例3处完全坏死，2例2处部分表面坏死经换药愈合，手术获得较好效果，其中18例患者经3～12个月随访，外观及功能恢复满意，现报告如下：     

旋转皮瓣在恶性皮肤肿瘤切除术后创面修复中的应用

目的 探讨针对皮肤恶性肿瘤切除术后的组织缺损使用旋转皮瓣转移术修复的临床效果。方法 对焦作市人民医院2016年1月至2021年8月收治的30例皮肤恶性肿瘤患者行皮肤恶性肿瘤切除术,缺损创面采用旋转皮瓣转移术修复。结果 术后30例皮瓣均未发生坏死,创面一期愈合,未出现皮瓣感染、血肿、皮瓣撕脱等并发症,成活率100.00%。供区愈合良好,未出现感染病例。30例患者均进行门诊或电话随访,在术后第3、6、12个月进行随访。随访结果皮瓣颜色与周围皮肤接近,血液循环良好,质地柔软,外形无臃肿,供区恢复良好,外形无明显异常;术区均未形成明显瘢痕,局部无明显牵拉变形等情况,外观形态及结构功能正常,无复发病例。结论 对于恶性皮肤肿瘤切除后造成的皮肤缺损,采用旋转皮瓣修复皮肤缺损操作简单易行,创面可以进行一期修复,无继发创面需要处理,术后疗效佳,患者承担手术痛苦小且经济压力小,无论是在手术操作还是患者对外观要求等方面,都得到实现及满足,值得推广应用。     

扩张皮瓣修复瘢痕及创面缺损

<正>皮肤软组织扩张术在国内经过20多年的发展,目前已趋成熟,越来越广泛地应用于临床。本组就64例患者治疗中对不同部位、不同缺损特点进行分析研究,总结出了一定的治疗经验供参考。     

Emerging drugs for diabetic foot ulcers

Diabetic foot ulceration results from factors extrinsic to the foot such as repeated trauma, ischaemia and infection, as well as intrinsic factors that lead to impairment of wound healing. Intrinsic factors are less well understood, but include deficiency of growth factors, changes in extracellular matrix components with excess proteases, reduced fibroblast activity, cellular abnormalities, deficiencies of angiogenesis, nitric oxide abnormalities and hyperglycaemia. The scientific rationale of therapy is to correct both the external factors that cause diabetic foot ulcers and the internal factors that lead to impairment of wound healing. Current research is leading to new therapies that can be divided into the following classes: growth factors, skin substitutes, extracellular matrix proteins, stem cell therapy, gene therapy, protease inhibitors, angiogenesis stimulants, nitric oxide-releasing agents, adenosine agonists, immunostimulants, vasoactive compounds and granulating agents. These therapies should be considered when existing treatments to correct extrinsic factors have failed to heal ulceration in the diabetic foot.     

Advancing pharmacotherapy for diabetic foot ulcers

Introduction: Standard treatment for diabetic foot ulcers (DFUs) includes off-loading, debridement, moisture balance, management of infection and peripheral arterial disease (PAD) as well as adequate glycemic control. The outcomes so far are unsatisfactory.

Areas covered: Herein, the authors provide an outline of newer pharmacological agents for the management of DFUs and give their expert perspectives on future treatment strategies.

Expert opinion: Evidence-based healthcare calls for high quality evidence from large RCTs before the implementation of new guidelines for the management of DFUs. Empagliflozin and liraglutide can be recommended for glucose control in patients with DFUs and PAD, while intensive lipid lowering therapy with evolocumab when primary cholesterol goals are not met could be offered to patients with DFUs. Further clinical studies are warranted to develop a structured algorithm for the treatment of DFUs that fail to heal after four weeks of current standard of care. Sucrose octasulfate dressings, becaplermin gel, and platelet-rich plasma (PRP) could also be considered as advanced treatment options for the management of hard to heal DFUs.     

In diabetic foot infections antibiotics are to treat infection,not to heal wounds

Introduction: Diabetic foot ulcers, especially when they become infected, are a leading cause of morbidity and may lead to severe consequences, such as amputation. Optimal treatment of these diabetic foot problems usually requires a multidisciplinary approach, typically including wound debridement, pressure off-loading, glycemic control, surgical interventions and occasionally other adjunctive measures.

Areas covered: Antibiotic therapy is required for most clinically infected wounds, but not for uninfected ulcers. Unfortunately, clinicians often prescribe antibiotics when they are not indicated, and even when indicated the regimen is frequently broader spectrum than needed and given for longer than necessary. Many agents are available for intravenous, oral or topical therapy, but no single antibiotic or combination is optimal. Overuse of antibiotics has negative effects for the patient, the health care system and society. Unnecessary antibiotic therapy further promotes the problem of antibiotic resistance.

Expert opinion: The rationale for prescribing topical, oral or parenteral antibiotics for patients with a diabetic foot wound is to treat clinically evident infection. Available published evidence suggests that there is no reason to prescribe antibiotic therapy for an uninfected foot wound as either prophylaxis against infection or in the hope that it will hasten healing of the wound.     

Treating diabetic ulcers

Introduction: Diabetic foot ulceration is a serious secondary complication of diabetes mellitus and the most common cause of hospitalization in diabetic patients. The etiology of diabetic foot ulcerations is complex due to their multifactorial nature. Thus, addressing all of the factors involved remains instrumental in wound healing.

Areas covered: The first part of this review focuses on the pathophysiology of diabetic foot ulceration and wound-healing impairment. The second part reviews the standard treatments, including advanced wound-care products and new therapeutic approaches currently under investigation. The reader will understand the most up-to-date research regarding the unique pathophysiology of diabetic foot ulceration along with the basic cornerstones of current recommended standard therapy.

Expert opinion: Diabetic foot ulceration is a serious complication that can lead – potentially – to devastating lower-extremity amputations. Proper adherence to standard treatment strategies can potentially prevent the need for amputation.     

综合疗法治疗糖尿病足溃疡54例

目的探讨糖尿病足溃疡综合治疗的疗效。方法选取54例糖尿病足溃疡患者,分为综合治疗组及对照组,观察治疗30 d后的有效率。结果综合治疗组总有效率明显高于对照组。结论综合治疗糖尿病足溃疡可显著提高疗效。     

Incretin-based therapy for diabetic ulcers: from bench to bedside

ABSTRACT

Introduction: Diabetic foot ulcers are a serious complication of diabetes and are associated with pain, disability, and poor quality of life. Incretin-based therapy is available for type-2 diabetes. Aside from glucose control, such treatment can impart numerous beneficial effects.

Areas covered: This review summarizes the preclinical and clinical evidence supporting incretin-based treatment approaches for diabetic ulcers.

Expert opinion: Incretin-based therapy may have a role in the treatment of diabetic foot ulcers; the benefits of such treatment arise from attenuation of inflammatory response, improvement of keratinocyte migration, induction of angiogenesis, and the enhancement of tissue remodeling. Large-scale clinical trials are required to determine the advantages of GLP-1 receptor agonists and DPP4 inhibitors. Future research on the topical application of incretin-based therapy is necessary. Such therapeutic approaches may provide new hope in improving the treatment of impaired diabetic foot ulcers.     

芦荟多糖对糖尿病足溃疡大鼠创面愈合的影响

目的 研究芦荟多糖对糖尿病足溃疡大鼠创面愈合的影响及相关机制.方法 采用腹腔注射1％链脲佐菌素(STZ)60 mg·kg-1的方法构建糖尿病大鼠模型,另选取15只大鼠为空白组,腹腔注射等量柠檬酸-柠檬酸钠缓冲液;糖尿病大鼠模型构建成功后制备糖尿病足溃疡创面模型.将糖尿病足溃疡大鼠随机分为模型组、实验组和对照组,各15只...     

Current and emerging therapies in the management of diabetic foot ulcers

Background:

Diabetic foot ulcers are one of the major causes of mortality in diabetic patients. Very few drugs and therapies have regulatory approval for this indication and several agents from diverse pharmacological classes are currently in various phases of clinical trials for the management of diabetic foot ulcers.

Scope:

The purpose of this review is to provide concise information of the drugs and therapies which are approved and present in clinical trials.

Review methods:

This review was carried out by systematic searches of relevant guidelines, patents, published articles, reviews and abstracts in PubMed/Medline, Web of Science, clinicaltrials.gov, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Google Scholar of all English language articles up to 1 March 2015. The following search terms were used: diabetes, diabetic foot, diabetic foot ulcer, diabetic wound, diabetic foot infections, wound management, randomized controlled trials, approved treatments, new treatments and clinical trials.

Conclusions:

The various drugs and therapies for the management of diabetic foot ulcers comprise antibiotics, neuropathic drugs, wound dressings, skin substitutes, growth factors and inflammatory modulators. The majority of these therapies target the treatment of diabetic foot ulcers to address the altered biochemical composition of the diabetic wound. However, no single treatment can be definitively recommended for the treatment of diabetic foot ulcers.     

监测足部皮肤温度预测糖尿病足溃疡的价值分析

目的探讨监测糖尿病足患者足部皮肤温度在预测糖尿病足溃疡中的意义。方法 选取2012年1月至2014年6月在华中科技大学同济医学院附属武汉中心医院门诊部行糖尿病足溃疡治疗及护理的86例患者,采用红外皮肤测温仪对所有参与者足部皮肤温度进行测试,然后比较足部皮肤温度差。所有参与者随访2年,依据Wagner分级标准判断糖尿病足溃疡病例。结果 足部皮肤温度差≥2 ℃的患者发生糖尿病足溃疡发生率为77.6%,明显高于足部皮肤温度差<2 ℃患者的51.4%,差异有统计学意义(χ²=6.475,P=0.011)。足部皮肤温度差与糖尿病足溃疡的严重程度呈正相关。结论 糖尿病足患者足部皮肤温度差异越大,则发生糖尿病足溃疡的可能性越大,溃疡严重程度也越大,这为预测糖尿病足溃疡的发生提供理论依据。