抗生素骨水泥联合游离股前外侧组织瓣序贯治疗糖尿病足溃疡的临床疗效

陈伟; 常树森; 周健; 张芳; 杨成兰; 聂开瑜; 邓呈亮; 魏在荣

doi:10.3760/cma.j.cn501225-20220628-00267

抗生素骨水泥联合游离股前外侧组织瓣序贯治疗糖尿病足溃疡的临床疗效

doi: 10.3760/cma.j.cn501225-20220628-00267

遵义医科大学附属医院烧伤整形外科，遵义　　563003

基金项目:

贵州省科技计划项目 2020-5012

省部共建协同创新中心项目 2020-39

遵义市科技计划项目 2021-3

国家自然科学基金地区科学基金项目 81760347

详细信息

通讯作者:
魏在荣，Email：zairongwei@163.com

计量
- 文章访问数: 2459
- HTML全文浏览量: 74
- PDF下载量: 85
- 被引次数: 0
出版历程
- 收稿日期: 2022-06-28

Clinical effects of antibiotic bone cement combined with free anterolateral thigh flap in sequential treatment of diabetic foot ulcer

Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China

Funds:

Science and Technology Plan Project of Guizhou Province of China 2020-5012

Collaborative Innovation Center of Chinese Ministry of Education 2020-39

Science and Technology Plan Project of Zunyi City 2021-3

Regional Science Foundation Program of National Natural Science Foundation of China 81760347

More Information

Corresponding author: Wei Zairong, Email: zairongwei@163.com

摘要

摘要: 目的探讨抗生素骨水泥联合游离股前外侧组织瓣序贯治疗糖尿病足溃疡（DFU）创面的临床疗效。方法采用回顾性观察性研究方法。遵义医科大学附属医院于2018年8月—2021年8月收治15例符合入选标准的DFU患者，其中男12例、女3例，年龄42~65岁，2型糖尿病病史5~19年。患者创面均合并局部骨骼、肌肉或肌腱缺损或外露，创面均于Ⅰ期清创后行抗生素骨水泥覆盖+Ⅱ期游离股前外侧嵌合穿支皮瓣（穿支皮瓣+肌瓣）或单纯游离股前外侧穿支皮瓣移植修复，拆除骨水泥并清创后的创面面积为9.0 cm×5.0 cm~20.0 cm×7.0 cm，皮瓣切取面积为10.0 cm×5.0 cm~22.0 cm×7.0 cm，肌瓣切取面积为5.0 cm×3.0 cm~8.0 cm×4.0 cm。组织瓣供区均直接缝合。随访时观察供区愈合情况、皮瓣成活情况。末次随访时，观察组织瓣质地、外形，双侧肢体有无新发溃疡，患者行走能力。结果 Ⅱ期术后随访8~21个月，供区均愈合良好，仅残留线性瘢痕；14例患者组织瓣完全成活，1例患者在Ⅱ期术后3周出现皮瓣部分坏死，经扩创+植皮后愈合。末次随访时，组织瓣质地良好、外形佳，患肢及对侧肢体无新发溃疡，患者日常行走功能无明显障碍。结论采用抗生素骨水泥联合游离股前外侧组织瓣修复DFU创面，可快速控制感染，术后皮瓣成活率较高，患者日常行走功能无明显障碍。
- 糖尿病足 /
- 穿支皮瓣 /
- 溃疡 /
- 显微外科手术 /
- 骨水泥 /
- 保肢
Abstract: Objective To investigate the clinical effects of antibiotic bone cement combined with free anterolateral thigh flap in sequential treatment of diabetic foot ulcer (DFU) wounds. Methods A retrospective observational study was conducted. From August 2018 to August 2021, 15 patients with DFU who met the inclusion criteria were admitted to the Affiliated Hospital of Zunyi Medical University, including 12 males and 3 females, aged 42-65 years, with a history of type 2 diabetes for 5-19 years. All the wounds of patients were complicated with local bone, muscle, or tendon defects or exposure. The wounds were covered with antibiotic bone cement after debridement in stage Ⅰ+free anterolateral thigh chimeric perforator flap (perforator flap+muscle flap) or simple free anterolateral thigh flap grafting in stage Ⅱ. The defect area of the wound after bone cement removal and debridement was 9.0 cm×5.0 cm-20.0 cm×7.0 cm, the incision area of the flap was 10.0 cm×5.0 cm-22.0 cm×7.0 cm, and the incision area of the muscle flap was 5.0 cm×3.0 cm-8.0 cm×4.0 cm. The donor sites of flaps were sutured directly. During follow-up, the situations of donor site healing and flap survival were observed. At the last follow-up, the texture and shape of the flap, the presence of new ulcers on both limbs, and the walking ability of the patient were observed. Results During the follow-up of 8 to 21 months after operation in stage Ⅱ, the donor sites healed well with only residual linear scar; flaps in 14 patients survived completely, and the flap in 1 patient developed partial necrosis at 3 weeks after stage Ⅱ surgery, which was healed after debridement and skin grafting. At the last follow-up, the flaps were good in texture and appearance, there were no new ulcers in the affected limb or opposite limb, and the patients had no obvious impairment in daily walking function. Conclusions To repair DFU wounds with antibiotic bone cement combined with free anterolateral thigh flap can rapidly control the infection, achieving a high survival rate of flap after operation with no obvious impairment in daily walking function of patients.
- Diabetic foot /
- Perforator flap /
- Ulcer /
- Microsurgery /
- Bone cement /
- Limb salvage
陈伟：起草文章并实施手术；常树森、周健：实施手术；张芳、杨成兰：病例随访以及数据采集；聂开瑜、邓呈亮、魏在荣：对文章进行批判性审阅，提供经费、技术支持

所有作者均声明不存在利益冲突

HTML全文

下载: 全尺寸图片幻灯片

1 抗生素骨水泥联合游离股前外侧组织瓣序贯治疗例1的2型糖尿病患者右足部溃疡创面。1A.Ⅰ期术前右侧患足外观；1B.Ⅰ期清创后，用抗生素骨水泥覆盖创面即刻；1C.Ⅱ期清创后即刻；1D.Ⅱ期术中切取的皮瓣；1E.Ⅱ期术后即刻；1F.Ⅱ期术后随访13个月，皮瓣外观良好

下载: 全尺寸图片幻灯片

2 抗生素骨水泥联合游离股前外侧穿支皮瓣序贯治疗例2的2型糖尿病患者左足部溃疡创面。2A.Ⅰ期术前左足外观；2B.Ⅰ期清创术后采用抗生素骨水泥覆盖创面即刻；2C.Ⅰ期术后4周，拆除抗生素骨水泥即刻；2D.Ⅱ期术中的皮瓣设计；2E.Ⅱ期术后即刻；2F.Ⅱ期术后随访8个月，皮瓣外观良好

下载: 全尺寸图片幻灯片

参考文献(26)

[1]	GazzarusoC, GallottiP, PujiaA, et al. Predictors of healing, ulcer recurrence and persistence, amputation and mortality in type 2 diabetic patients with diabetic foot: a 10-year retrospective cohort study[J]. Endocrine, 2021, 71(1): 59-68. DOI: 10.1007/s12020-020-02431-0.
[2]	UgwuE, AdeleyeO, GezawaI, et al. Predictors of lower extremity amputation in patients with diabetic foot ulcer: findings from MEDFUN, a multi-center observational study [J]. J Foot Ankle Res, 2019, 12:34. DOI: 10.1186/s13047-019-0345-y.
[3]	YektaZ, PouraliR, NezhadrahimR, et al. Clinical and behavioral factors associated with management outcome in hospitalized patients with diabetic foot ulcer[J]. Diabetes Metab Syndr Obes, 2011, 4: 371-375. DOI: 10.2147/DMSO.S25309.
[4]	ChenP, CallisayaM, WillsK, et al. Associations of health literacy with risk factors for diabetic foot disease: a cross-sectional analysis of the Southern Tasmanian Health Literacy and Foot Ulcer Development in Diabetes Mellitus Study[J]. BMJ Open, 2019, 9(7):e025349. DOI: 10.1136/bmjopen-2018-025349.
[5]	MauricioD, JudeE, PiaggesiA, et al. Diabetic foot: current status and future prospects[J]. J Diabetes Res, 2016, 2016:5691305. DOI: 10.1155/2016/5691305.
[6]	OhTS, LeeHS, HongJP. Diabetic foot reconstruction using free flaps increases 5-year-survival rate[J]. J Plast Reconstr Aesthet Surg,2013,66(2): 243-250. DOI: 10.1016/j.bjps.2012.09.024.
[7]	EdmondsM, Lázaro-MartínezJL, Alfayate-GarcíaJM, et al. Sucrose octasulfate dressing versus control dressing in patients with neuroischaemic diabetic foot ulcers (Explorer): an international, multicentre, double-blind, randomised, controlled trial[J]. Lancet Diabetes Endocrinol,2018,6(3):186-196.DOI: 10.1016/S2213-8587(17)30438-2.
[8]	李颜沁, 胥学冰, 张华, 等. 蔗糖八硫酸盐敷料在治疗糖尿病足溃疡慢性伤口中的获益研究进展[J].中华糖尿病杂志,2021,13(12):1190-1192. DOI: 10.3760/cma.j.cn115791-20211027-00575.
[9]	牛彩丽,黄锐娜,徐滋琪,等. 富血小板血浆治疗DFU创面:疗效及安全性的Meta分析[J]. 中国组织工程研究,2019,23(14):2285-2291. DOI: 10.3969/j.issn.2095-4344.1663.
[10]	AhmedM, ReffatSA, HassanA, et al. Platelet-rich plasma for the treatment of clean diabetic foot ulcers[J]. Ann Vasc Surg, 2017, 38:206-211. DOI: 10.1016/j.avsg.2016.04.023.
[11]	YarahmadiA, Saeed ModagheghMH, Mostafavi-PourZ, et al. The effect of platelet-rich plasma-fibrin glue dressing in combination with oral vitamin E and C for treatment of non-healing diabetic foot ulcers: a randomized, double-blind, parallel-group, clinical trial[J]. Expert Opin Biol Ther, 2021, 21(5): 687-696. DOI: 10.1080/14712598.2021.1897100.
[12]	中华医学会糖尿病学分会, 中华医学会感染病学分会, 中华医学会组织修复与再生分会. 中国糖尿病足防治指南(2019版)(Ⅱ)[J].中华糖尿病杂志,2019,11(3):161-189. DOI: 10.3760/cma.j.issn.1674-5809.2019.03.005.
[13]	LiuC, YouJX, ChenYX, et al. Effect of induced membrane formation followed by polymethylmethacrylate implantation on diabetic foot ulcer healing when revascularization is not feasible[J]. J Diabetes Res, 2019,2019:2429136. DOI: 10.1155/2019/2429136.
[14]	DengCL, ChangSS, WeiZR, et al. Alternative design for anterolateral thigh multi-paddled flaps: the 3-5 system[J]. Med Sci Monitor, 2018, 24: 9102-9109. DOI: 10.12659/MSM.911883.
[15]	黄红军,牛希华,杨冠龙,等. 抗生素骨水泥在糖尿病足溃疡创面应用的临床效果[J]. 中华烧伤杂志,2019,35(6):464-466. DOI: 10.3760/cma.j.issn.1009-2587.2019.06.013.
[16]	LeeZH, DaarDA, StranixJT, et al. Free-flap reconstruction for diabetic lower extremity limb salvage[J]. J Surg Res, 2020, 248:165-170. DOI: 10.1016/j.jss.2019.12.008.
[17]	李小兵,刘洪均,杨超,等. 带阔筋膜游离股前外侧皮瓣修复糖尿病足溃疡伴骨外露[J]. 中国修复重建外科杂志,2022,36(1):86-91. DOI: 10.7507/1002-1892.202108110.
[18]	蒋玲丽,李海,魏在荣,等. 股前外侧嵌合穿支皮瓣修复糖尿病足溃疡创面[J]. 中华显微外科杂志,2021,44(2):141-145. DOI: 10.3760/cma.j.cn441206-20200813-00320.
[19]	杨力,李科霖,庞远翔,等. 游离旋股外侧动脉降支组织瓣修复Wagner 3级或4级糖尿病足创面的临床效果[J]. 中华烧伤与创面修复杂志,2022,38(12):1148-1155. DOI: 10.3760/cma.j.cn501225-20220321-00076.
[20]	HashimotoI, AbeY, MorimotoA, et al. Limb salvage and vascular augmentation by microsurgical free flap transfer for treatment of neuropathic diabetic foot ulcers[J]. J Med Invest, 2014, 61(3/4):325-332. DOI: 10.2152/jmi.61.325.
[21]	Fitzgerald O'ConnorEJ, VeselyM, HoltPJ, et al. A systematic review of free tissue transfer in the management of non-traumatic lower extremity wounds in patients with diabetes[J]. Eur J Vasc Endovasc Surg, 2011, 41(3): 391-399. DOI: 10.1016/j.ejvs.2010.11.013.
[22]	OuCY, WuMS, LinMC, et al. Short-term and long-term outcomes of free flap reconstruction versus amputation for diabetic foot reconstruction in patients with end-stage renal disease[J]. J Plast Reconstr Aesthet Surg, 2022, 75(8):2511-2519. DOI: 10.1016/j.bjps.2022.04.024.
[23]	ChouC, KuoPJ, ChenYC, et al. Combination of vascular intervention surgery and free tissue transfer for critical diabetic limb salvage[J]. Ann Plast Surg, 2016, 77 Suppl 1: S16-21. DOI: 10.1097/SAP.0000000000000812.
[24]	KimJY, LeeYJ. A study of the survival factors of free flap in older diabetic patients[J]. J Reconstr Microsurg, 2007, 23(7): 373-380. DOI: 10.1055/s-2007-992345.
[25]	ThaiDQ, LeeDH, LeeWB, et al. What is the impact of infrapopliteal endovascular intervention on free flap survival in diabetic foot reconstruction? [J]. J Orthop Surg Res, 2021, 16(1):42. DOI: 10.1186/s13018-020-02173-9.
[26]	IlligKA, MoranS, SerlettiJ, et al. Combined free tissue transfer and infrainguinal bypass graft: an alternative to major amputation in selected patients[J]. J Vasc Surg, 2001, 33:17-23. DOI: 10.1067/mva.2001.112301.