带蒂皮瓣联合膜诱导技术修复糖尿病患者足踝部创面的效果

郭晓峰; 邓鑫鑫; 黄治虎; 薛明宇; 卜凡玉

doi:10.3760/cma.j.cn501225-20221212-00534

带蒂皮瓣联合膜诱导技术修复糖尿病患者足踝部创面的效果

doi: 10.3760/cma.j.cn501225-20221212-00534

无锡市第九人民医院创面修复科，无锡　　214000

基金项目:

无锡市卫生健康委员会科技成果与适宜技术推广项目 T2020122

无锡市政府太湖人才计划项目 2020WXTH-14

详细信息

通讯作者:
卜凡玉，Email：bufanyu1020@163.com

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出版历程
- 收稿日期: 2022-12-12

Effects of pedicled flap combined with membrane induction technique in repairing foot and ankle wounds in diabetic patients

Department of Wound Repair, Wuxi Ninth People's Hospital, Wuxi 214000, China

Funds:

Scientific and Technological Achievements and Suitable Technology Promotion Project of Wuxi Municipal Health Commission T2020122

Taihu Lake Talent Plan Project of Wuxi Municipal Government 2020WXTH-14

More Information

Corresponding author: Bu Fanyu, Email: bufanyu1020@163.com

摘要

摘要: 目的探讨采用带蒂皮瓣联合膜诱导技术修复糖尿病患者足踝部创面的效果。方法采用回顾性观察性研究方法。2019年3月—2021年7月，无锡市第九人民医院收治12例符合入选标准的糖尿病足踝部创面患者，其中男7例、女5例，年龄20~92岁。清创前创面面积为4.0 cm×2.5 cm~16.0 cm×12.5 cm。患者均于Ⅰ期行清创+抗生素骨水泥填塞；Ⅱ期根据创面位置，采用腓动脉穿支皮瓣或胫后动脉穿支皮瓣修复创面，皮瓣切取面积为4.5 cm×3.0 cm~18.5 cm×14.0 cm。4例患者供区直接缝合，8例患者供区取腹股沟全厚皮片覆盖。Ⅱ期术后随访皮瓣和皮片的成活情况，皮瓣供受区瘢痕情况以及皮瓣外观，患肢踝关节功能。末次随访时，采用美国足踝外科协会（AOFAS）踝-后足评分系统评估足踝部功能恢复情况并评级。结果 Ⅱ期术后随访4~15个月，皮瓣与皮片均成活，无明显感染复发，皮瓣供受区均遗留线性瘢痕，皮瓣外观良好，患肢踝关节功能接近正常。末次随访时，患者AOFAS评分为79~93分，评级为优者8例、良者4例。结论带蒂皮瓣联合膜诱导技术修复糖尿病患者足踝部创面具有操作简单、可保全踝关节功能、术后感染复发少的优点，值得在临床上推广应用。
- 外科皮瓣 /
- 骨水泥成形术 /
- 糖尿病足 /
- 足损伤 /
- 创面修复
Abstract: Objective To explore the effects of pedicled flap combined with membrane induction technique in repairing foot and ankle wounds in diabetic patients. Methods A retrospective observational study was conducted. From March 2019 to July 2021, 12 patients with diabetic foot and ankle wounds who met the inclusion criteria were admitted to Wuxi Ninth People's Hospital, including 7 males and 5 females, aged 20 to 92 years. The wound area before debridement was 4.0 cm×2.5 cm to 16.0 cm×12.5 cm. The patients underwent debridement+antibiotic cement tamponade in stage Ⅰ; according to the wound site, peroneal artery perforator flap or posterior tibial artery perforator flap was chosen to repair the wound in stage Ⅱ, with the area of the resected flap ranging from 4.5 cm×3.0 cm to 18.5 cm×14.0 cm. The donor site was directly closed in 4 patients or covered by full-thickness inguinal skin graft in 8 patients. After the operation of stage Ⅱ, the survival of flap and skin graft, the scar in donor and recipient sites of flap, the appearance of flap, and the function of ankle joint of affected extremity were followed up. The recovery of foot and ankle function was evaluated and rated by the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scoring System at the last follow-up. Results During the follow-up of 4 to 15 months after the operation of stage Ⅱ, both the flap and skin graft survived, without obvious infection recurrence. Linear scars were left in donor and recipient sites of flap, with good appearance in flap. The function of ankle joint in the affected extremity was nearly normal. At the last follow-up, the AOFAS scores of patients were 79 to 93, with excellent in 8 cases and good in 4 cases. Conclusions The pedicled flap combined with membrane induction technique for repairing foot and ankle wounds in diabetic patients has the advantage of simple operation, preserved ankle joint function, and less postoperative infection recurrence, which is worth popularizing in clinical practice.
- Surgical flaps /
- Cementoplasty /
- Diabetic foot /
- Foot injuries /
- Wound repair
郭晓峰：手术操作、数据收集、论文撰写；邓鑫鑫：手术操作；黄治虎：论文修改；薛明宇：研究指导、手术操作、论文修改；卜凡玉：研究指导、手术操作、论文修改、基金支持

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参考文献(22)

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1 腓动脉穿支皮瓣联合膜诱导技术修复糖尿病合并右足跟后侧跟腱外露创面。1A.入院时创面可见跟腱区窦道及跟腱外露；1B.Ⅰ期术中见外踝前方至跟腱内侧溃烂感染、深及骨面，跟腱表面感染；1C.Ⅰ期术中彻底清创清除深部筋膜组织，保留跟腱；1D.Ⅰ期手术填塞抗生素（庆大霉素）骨水泥包裹跟腱后；1E.Ⅱ期术中根据创面形状设计皮瓣；1F.Ⅱ期术中切取皮瓣；1G.Ⅱ期术中皮瓣覆盖创面，皮瓣供区植皮；1H.Ⅱ期术后6个月见皮瓣外观良好、无臃肿，遗留轻度瘢痕

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