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): 311-318
Cao T,Ji P,Zhang Z,et al.A prospective randomized controlled study of antibiotic bone cement in the treatment of diabetic foot ulcer[J].Chin J Burns Wounds,2023,39(4):311-318.DOI: 10.3760/cma.j.cn501225-20221111-00485.
Citation: Cao T,Ji P,Zhang Z,et al.A prospective randomized controlled study of antibiotic bone cement in the treatment of diabetic foot ulcer[J].Chin J Burns Wounds,2023,39(4):311-318.DOI: 10.3760/cma.j.cn501225-20221111-00485.
shu

A prospective randomized controlled study of antibiotic bone cement in the treatment of diabetic foot ulcer

doi: 10.3760/cma.j.cn501225-20221111-00485

  • Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China

Funds:

General Program of National Natural Science Foundation of China 82272269

More Information
    Abstract
  •   Objective   To investigate the clinical effects and related mechanism of antibiotic bone cement in treating diabetic foot ulcer (DFU).   Methods   A prospective randomized controlled study was conducted. From August 2020 to August 2022, 24 patients with DFU who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University. According to the block randomization, the patients were divided into 2 groups, with 12 patients in each group. In antibiotic bone cement group, there were 7 male and 5 female patients, aged (64±8) years, with the ulcer area of (41±21) cm 2. In silver sulfadiazine group, there were 8 male and 4 female patients, aged (62±8) years, with the ulcer area of (38±19) cm 2. Under the condition of ensuring the patency of at least one main inferior genicular artery in each patient, the continuous vacuum sealing drainage was performed for 3-5 days after thorough debridement. Thereafter, the wounds in antibiotic bone cement group were treated with gentamicin-laden bone cement, and the wounds in silver sulfadiazine group were treated with silver sulfadiazine cream for dressing change. After 3 weeks of dressing change, the wound was covered with split-thickness skin graft from the lateral thigh on the affected side. Before debridement and after 3 weeks of dressing change, the blood flow intensities of wound tissue and normal skin tissue in foot were measured using laser Doppler flowmeter, and then, the percentage of relative blood flow intensity of wound and the change rate of blood flow intensity were calculated. After 3 weeks of dressing change, the wound margin tissue was taken, the number of CD31-positive neovascular and the vascular morphology were observed and detected by immunohistochemical staining, the morphology of blood vessels surrounded by CD31 and α-smooth muscle actin (α-SMA) double-positive cells was observed by immunofluorescence staining, the cell proliferation activity was evaluated by immunofluorescence staining (denoted as the ratio of Ki67 positive cells), and the protein expression of vascular endothelial growth factor receptor 2 (VEGFR2) was detected by Western blotting. The skin graft survival was observed 3-5 days after skin grafting, and the wound healing time was recorded. Data were statistically analyzed with independent sample t test and Fisher's exact probability test.   Results   The percentages of relative blood flow intensity of wounds of patients before debridement were similar between the two groups ( P>0.05). After 3 weeks of dressing change, the percentage of relative blood flow intensity of wounds and the change rate of blood flow intensity of patients in antibiotic bone cement group were (44.7±2.0)% and (129±12)%, respectively, which were significantly higher than (28.3±1.2)% and (41±8)% in silver sulfadiazine group (with t values of 24.15 and 20.97, respectively, P<0.05). After 3 weeks of dressing change, compared with those in silver sulfadiazine group, the number of CD31-positive neovascular in the wound margin tissue of patients in antibiotic bone cement group was significantly increased ( t=33.81, P<0.05) with larger diameter and more regular arrangement, the vascular wall continuity surrounded by CD31 and α-SMA double-positive cells was better, and the ratio of Ki67 positive cells and protein expression of VEGFR2 were significantly increased (with t values of 40.97 and 47.38, respectively, P<0.05). On post skin grafting day 3-5, all the patients in antibiotic bone cement group and 8 patients in silver sulfadiazine group had good skin graft survival, while 4 patients in silver sulfadiazine group showed spotted/patchy skin graft necrosis, which were cured after corresponding treatment. The wound healing time of patients in antibiotic bone cement group was (47.1±2.9) d, which was significantly shorter than (58.8±2.3) d in silver sulfadiazine group ( t=10.86, P<0.05).   Conclusions   Compared with silver sulfadiazine, clinical application of antibiotic bone cement for treating DFU has the characteristics of accelerating wound healing and better reconstruction of local blood flow, which may be closely related to the fact that antibiotic bone cement promoted the local angiogenesis effectively in the wound through enhancing the expression of VEGFR2.

     

    • FullText(HTML)
  • loading
    • References(30)
  • [1]
    SunY,GaoY,ChenJ,et al.Evidence mapping of recommendations on diagnosis and therapeutic strategies for diabetes foot: an international review of 22 guidelines[J].Metabolism,2019,100:153956.DOI: 10.1016/j.metabol.2019.153956.
    [2]
    Monteiro-SoaresM,RussellD,BoykoEJ,et al.Guidelines on the classification of diabetic foot ulcers (IWGDF 2019)[J].Diabetes Metab Res Rev,2020,36Suppl 1:Se3273.DOI: 10.1002/dmrr.3273.
    [3]
    TongT,YangC,TianW,et al.Phenotypes and outcomes in middle-aged patients with diabetic foot ulcers: a retrospective cohort study[J].J Foot Ankle Res,2020,13(1):24.DOI: 10.1186/s13047-020-00386-z.
    [4]
    JupiterDC,ThorudJC,BuckleyCJ,et al.The impact of foot ulceration and amputation on mortality in diabetic patients. I: from ulceration to death, a systematic review[J].Int Wound J,2016,13(5):892-903.DOI: 10.1111/iwj.12404.
    [5]
    ArmstrongDG,SwerdlowMA,ArmstrongAA,et al.Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer[J].J Foot Ankle Res,2020,13(1):16.DOI: 10.1186/s13047-020-00383-2.
    [6]
    LimJZ,NgNS,ThomasC.Prevention and treatment of diabetic foot ulcers[J].J R Soc Med,2017,110(3):104-109.DOI: 10.1177/0141076816688346.
    [7]
    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.
    [8]
    NiikuraT,JimboN,KomatsuM,et al.Histological analysis of induced membranes in patients whose bone defects were treated with the Masquelet technique to identify factors affecting the vascularity of induced membranes[J].J Orthop Surg Res,2021,16(1):248.DOI: 10.1186/s13018-021-02404-7.
    [9]
    GhoshS,SinhaM,SamantaR,et al.A potent antibiotic-loaded bone-cement implant against staphylococcal bone infections[J].Nat Biomed Eng,2022,6(10):1180-1195.DOI: 10.1038/s41551-022-00950-x.
    [10]
    MathieuL,MourtialonR,DurandM,et al.Masquelet technique in military practice: specificities and future directions for combat-related bone defect reconstruction[J].Mil Med Res,2022,9(1):48.DOI: 10.1186/s40779-022-00411-1.
    [11]
    AlfordAI,NicolaouD,HakeM,et al.Masquelet's induced membrane technique: review of current concepts and future directions[J].J Orthop Res,2021,39(4):707-718.DOI: 10.1002/jor.24978.
    [12]
    YaoJ,ZengY,YangJ,et al.Repairing tendon-exposed wounds by combing the Masquelet technique with dermoplasty[J].Front Surg,2022,9:995316.DOI: 10.3389/fsurg.2022.995316.
    [13]
    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.
    [14]
    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)(Ⅰ)[J].中华糖尿病杂志,2019,11(2):92-108.DOI: 10.3760/cma.j.issn.1674-5809.2019.02.004.
    [15]
    JiS,LiuX,HuangJ,et al.Consensus on the application of negative pressure wound therapy of diabetic foot wounds[J/OL].Burns Trauma,2021,9:tkab018[2022-08-06].https://pubmed.ncbi.nlm.nih.gov/34212064/.DOI: 10.1093/burnst/tkab018.
    [16]
    WackenforsA,SjögrenJ,GustafssonR,et al.Effects of vacuum-assisted closure therapy on inguinal wound edge microvascular blood flow[J].Wound Repair Regen,2004,12(6):600-606.DOI: 10.1111/j.1067-1927.2004.12602.x.
    [17]
    Van NettenJJ,WoodburnJ,BusSA.The future for diabetic foot ulcer prevention: a paradigm shift from stratified healthcare towards personalized medicine[J].Diabetes Metab Res Rev,2020,36Suppl 1:Se3234.DOI: 10.1002/dmrr.3234.
    [18]
    CavanaghPR,LipskyBA,BradburyAW,et al.Treatment for diabetic foot ulcers[J].Lancet,2005,366(9498):1725-1735.DOI: 10.1016/S0140-6736(05)67699-4.
    [19]
    OkonkwoUA,DiPietroLA.Diabetes and wound angiogenesis[J].Int J Mol Sci,2017,18(7):1419.DOI: 10.3390/ijms18071419.
    [20]
    SloanG,SelvarajahD,TesfayeS.Pathogenesis, diagnosis and clinical management of diabetic sensorimotor peripheral neuropathy[J].Nat Rev Endocrinol,2021,17(7):400-420.DOI: 10.1038/s41574-021-00496-z.
    [21]
    NowakNC,MenichellaDM,MillerR,et al.Cutaneous innervation in impaired diabetic wound healing[J].Transl Res,2021,236:87-108.DOI: 10.1016/j.trsl.2021.05.003.
    [22]
    O'BrienTD.Impaired dermal microvascular reactivity and implications for diabetic wound formation and healing: an evidence review[J].J Wound Care,2020,29(Suppl9):S21-28.DOI: 10.12968/jowc.2020.29.Sup9.S21.
    [23]
    中国医疗保健国际交流促进会糖尿病足病分会,国际血管联盟中国分部糖尿病足病专家委员会.中国糖尿病足诊治指南[J].中国临床医生杂志,2020,48(1):19-27.DOI: 10.3969/j.issn.2095-8552.2020.01.007.
    [24]
    LoZJ,ChandrasekarS,YongE,et al.Clinical and economic outcomes of a multidisciplinary team approach in a lower extremity amputation prevention programme for diabetic foot ulcer care in an Asian population: a case-control study[J].Int Wound J,2022,19(4):765-773.DOI: 10.1111/iwj.13672.
    [25]
    LiuZ,DumvilleJC,HinchliffeRJ,et al.Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus[J].Cochrane Database Syst Rev,2018,10(10):CD010318.DOI: 10.1002/14651858.CD010318.pub3.
    [26]
    SunYW,LiL,ZhangZH.Antibiotic-loaded bone cement combined with vacuum-assisted closure facilitating wound healing in Wagner 3-4 diabetic foot ulcers[J/OL].Int J Low Extrem Wounds,2022:15347346221109045(2022-06-15)[2022-11-11]. https://pubmed.ncbi.nlm.nih.gov/35706401/.DOI:10.1177/15347346221109045. [published online ahead of print].
    [27]
    HsiehPH,TaiCL,LeePC,et al.Liquid gentamicin and vancomycin in bone cement: a potentially more cost-effective regimen[J].J Arthroplasty,2009,24(1):125-130.DOI: 10.1016/j.arth.2008.01.131.
    [28]
    PeachCJ,MignoneVW,ArrudaMA,et al.Molecular pharmacology of VEGF-A isoforms: binding and signalling at VEGFR2[J].Int J Mol Sci,2018,19(4):1264.DOI: 10.3390/ijms19041264.
    [29]
    HuangX,LiangP,JiangB,et al.Hyperbaric oxygen potentiates diabetic wound healing by promoting fibroblast cell proliferation and endothelial cell angiogenesis[J].Life Sci,2020,259:118246.DOI: 10.1016/j.lfs.2020.118246.
    [30]
    ZhouHJ,XuZ,WangZ,et al.SUMOylation of VEGFR2 regulates its intracellular trafficking and pathological angiogenesis[J].Nat Commun,2018,9(1):3303.DOI: 10.1038/s41467-018-05812-2.
    • 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(6)  / Tables(2)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (6123) PDF downloads(1145) 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