中国修复重建外科杂志

中国修复重建外科杂志

皮肤牵张闭合器在糖尿病足创面修复中的应用

查看全文

目的 探讨皮肤牵张闭合器在糖尿病足创面修复中的临床应用价值。 方法 回顾分析 2015 年 10 月—2016 年 7 月,采用皮肤牵张闭合器治疗的 24 例糖尿病足患者(试验组)临床资料,与同期采用封闭式负压引流联合植皮修复的 24 例患者(对照组)进行比较。两组患者性别、年龄、侧别、病程、TEXAS 分级分期等一般资料比较,差异均无统计学意义(P>0.05)。两组患者均根据细菌培养结果,同时应用敏感抗生素治疗。 结果 术后试验组及对照组各 1 例发生感染,均经对症处理后创面愈合。其余患者创面均顺利愈合,其中试验组愈合时间为(12.8±11.6)d,较对照组(22.3±10.4)d 显著缩短,比较差异有统计学意义(t=2.987,P=0.005)。两组患者术后均获随访,随访时间 3~12 个月,创面无裂开,随访期间溃疡无复发。 结论 与封闭式负压引流联合植皮修复相比,应用皮肤牵张闭合器治疗糖尿病足创面更简便,能缩短创面愈合时间,且创面愈合后与邻近皮肤相似。

Objective To evaluate the clinical value of skin stretching device in repair of diabetic foot wound. Methods A retrospective analysis was made on the clinical data of 48 cases with diabetic foot wound who were treated with skin stretching device (trial group, n=24) and with the vacuum sealing drainage combined with skin graft (control group, n=24) respectively between October 2015 and July 2016. There was no significant difference in gender, age, side, course of disease, TEXAS stage between 2 groups (P>0.05). Both patients in 2 groups were treated with sensitive antibiotics according to the results of bacterial culture. Results One case in control group was infected and the skin graft failed, and 1 case in trial group was infected after the treatment, and the two wounds healed after symptomatic treatment. The wounds of the other patients healed successfully, and the healing time of the trial group was significantly shorter than the control group [(12.8±11.6) days vs. (22.3±10.4) days; t=2.987, P=0.005). All patients were followed up 3-12 months after operation, and no wound dehiscence or recurrence occurred during follow-up. Conclusion Compared with the vacuum sealing drainage combined with skin graft, the application of skin stretching device in the repair of diabetic foot wound has advantages, such as easy to operate, shorten the wound healing time, and the wound was similar with the adjacent skin.

关键词: 糖尿病足; 皮肤牵张闭合器; 封闭式负压引流; 植皮; 创面愈合

Key words: Diabetic foot; skin stretching device; vacuum sealing drainage; skin graft; wound healing

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. 张敏, 李建香, 马文静, 等. 我国糖尿病流行病学和疾病经济负担研究现状. 世界最新医学信息文摘, 2017, 17(56): 176.
2. Sanz-Corbalán I, Lázaro-Martínez JL, García-Morales E, et al. Advantages of early diagnosis of diabetic neuropathy in the prevention of diabetic foot ulcers. Diabetes Res Clin Pract, 2017. [Epub ahead of print]
3. Sekhar MS, Mk U, Vyas N, et al. Development and evaluation of patient information leaflet for diabetic foot ulcer patients. Int J Endocrinol Metab, 2017, 15(3): e55454.
4. Armstrong DG. The University of Texas Diabetic Foot Classification System. Ostomy Wound Manage, 1996, 42(8): 60-61.
5. 鲁明, 张振, 宋明智, 等. 拉杆式皮肤扩展器Ⅰ期闭合筋膜间室切开减压术后创面. 中华创伤杂志, 2016, 32(3): 249-251.
6. 苑博, 王寿宇, 梁海东, 等. 新型拉杆式皮肤牵张器在修复 26 例患者四肢皮肤软组织缺损中的应用. 中华烧伤杂志, 2016, 32(12): 732-734.
7. 任高宏, 黎健伟, 黎润光, 等. 桥式皮瓣联合游离植皮负压封闭引流修复下肢大面积环形软组织缺损. 中华外科杂志, 2012, 50(1): 39-44.
8. 徐成, 鲁延林, 范锟铻. 负压封闭引流在糖尿病足治疗中的应用研究. 中国临床研究, 2016, 29(5): 627-628.
9. 朱新华, 柴益民, 叶吉忠, 等. 负压封闭引流和传统修复方法促进糖尿病足愈合的比较. 中国组织工程研究, 2014, 18(34): 5548-5554.
10. Takei T, Danjo S, Sakoguchi S, et al. Autoclavable physically-crosslinked chitosan cryogel as a wound dressing. Biosci Bioeng, 2017. [Epub ahead of print]
11. Hodgson H, Davidson D, Duncan A, et al. Clinical evaluation of a hydro-responsive wound dressing: the Glasgow experience. J Wound Care, 2017, 26(11): 642-650.
12. De Marchi JGB, Jornada DS, Silva FK. Triclosan resistance reversion by encapsulation in chitosan-coated-nanocapsule containing α-bisabolol as core: development of wound dressing. Int J Nanomedicine, 2017, 12: 7855-7868.
13. von Cramon L, Markowicz M, Nebendahl J, et al. A clinical evaluation of a transparent, absorbent, adhesive wound dressing. Br J Nurs, 2017, 26(Sup20): S46-S53.
14. Hirshowitz B, Lindenbaum E, Har-Shai Y. A skin-stretching device for the harnessing of the viscoelastic properties of skin. Plast Reconstr Surg, 1993, 92(2): 260-270.
15. Melis P, Noorlander ML, van der Horst CM, et al. Rapid alignment of collagen fibers in the dermis of undermined and not undermined skin stretched with a skin-stretching device. Plast Reconstr Surg, 2002, 109(2): 674-680.
16. Pavletic MM. Use of an external skin-stretching device for wound closure in dogs and cats. J Am Vet Med Assoc, 2000, 217(3): 350-354.
17. Melis P, Bos KE, Horenblas S. Primary skin closure of a large groin defect after inguinal lymphadenectomy for penile cancer using a skin stretching device. J Urol, 1998, 159(1): 185-187.
18. Song M, Zhang Z, Liu T. EASApprox® skin-stretching system: A secure and effective method to achieve wound closure. Exp Ther Med, 2017, 14(1): 531-538.
19. 董其强, 谷国俊, 王礼军, 等. 改良可调式皮肤牵张闭合器在皮肤及软组织缺损修复中的应用. 中国修复重建外科杂志, 2017, 31(12): 1481-1484.
20. Cheng LF, Lee JT, Hsu H, et al. Simple skin-stretching device in assisted tension-free wound closure. Ann Plast Surg, 2017, 78(3 Suppl 2): S52-S57.