糖尿病足溃疡外科修复的临床分析

目的分析总结糖尿病足（diabeticfoot,DF）溃疡外科修复的临床治疗经验。方法回顾性分析2010年1月至2012年12月重庆医科大学附属第一医院烧伤整形外科收治的85例（108条患肢）DF患者的临床资料。结果①85例中DF创面培养结果：共培养出142株细菌,7例真菌感染,感染以金黄色葡萄球菌、大肠埃希菌、凝固酶阴性葡萄球菌、肠球菌、铜绿假单胞菌、鲍曼不动杆菌为主。②DF的愈合情况与Wagner分级呈负相关性：分级越高,一期愈合越低,截趾（肢）率及二期或多期愈合越高,愈合时间及平均住院时间越长。③对85例DF患者行手术治疗,植皮术为45例（52．9％）,皮瓣修复8例（9．4％）,皮瓣修复＋植皮术为7例,28例截趾（肢）术,扩创后直接缝合2例。经1次或多次手术治疗后创面全部愈合,随访10d～2个月溃疡无复发,修复部位无迟发感染,外形及负重行走功能良好。结论DF的治疗需要遵循多学科合作、专业化治疗、全身治疗与局部治疗的原则。需要重视病因、积极预防、加强创面床准备,选择最佳治疗方案,早期手术,才能促进创面愈合。

Surgical treatment for diabetic foot ulcers

Objective To get the experience of surgical treatment for diabetic foot （DF） ulcer. Methods Clinical data of 85 patients （108 limbs in total） admitted in Department of Burn and Plastic Surgery in The First Affiliated Hospital of Chongqing Medical University from Jan 2010 to Dee 2012 were retrospectively analyzed. Results Wound culture results of the 85 patients were ： bacteria in 142 limbs, and fungi in 7 limbs. The main bacteria cultured were staphylococcus aureus, eseheriehia coli, eoagulase negative staphylococcus, enterococeus, pseudomonas aeruginosa, and acinetobaeter baumannii. DF healing and Wagner classification was negatively correlated ： the higher the class, the less the primary healing rate. The higher amputation rate were found in the higher class patients. The more delayed healing, and the longer the healing time and average hospital stay were also found in the higher class patients. 85 patients underwent surgery： skin grafting in 45 eases （52.9%）, flap in 8 cases （9.4%）, skin repair ＋flap grafting in 7 cases, toe （limb） amputation in 28 cases, 2 eases were sutured after debridement. All cases were cured after one or multiple surgeries. No recurrence was found during the follow-up of 10 days to 2 months. No delayed infection occurred to the repairments. The shape and weight bearing walking function were good. Conclusions The treatment of DF need to follow the principle of multidisciplinary cooperation, professional treatment, systemic and local treatment. We need to pay attention to the etiology and prevention of the disease, focus on wound bed preparation, choose the best treat- ment. Early operation can significantly fascilitate wound healing.