Email Alerts
RSS
Volume 39 Issue 4
Apr.  2023
Turn off MathJax
Article Contents
Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2023  >  39(4): 319-324
Chen W,Chang SS,Zhou J,et al.Clinical effects of antibiotic bone cement combined with free anterolateral thigh flap in sequential treatment of diabetic foot ulcer[J].Chin J Burns Wounds,2023,39(4):319-324.DOI: 10.3760/cma.j.cn501225-20220628-00267.
Citation: Chen W,Chang SS,Zhou J,et al.Clinical effects of antibiotic bone cement combined with free anterolateral thigh flap in sequential treatment of diabetic foot ulcer[J].Chin J Burns Wounds,2023,39(4):319-324.DOI: 10.3760/cma.j.cn501225-20220628-00267.
shu

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

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

  • 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
    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.

     

    • FullText(HTML)
  • loading
    • References(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.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(3)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (2598) PDF downloads(92) Cited by()
    Proportional views
    Related

    Copyright © Chinese Journal of Burns京ICP备07035254号-14

    E-mail：shaoshangzazhi@163.com

    Website：https://zhsszz.xml-journal.net/

    Supported by: Beijing Renhe Information Technology Co. Ltd    

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return