Email Alerts
RSS
Volume 39 Issue 12
Dec.  2023
Turn off MathJax
Article Contents
Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2023  >  39(12): 1158-1162
Guo XF,Jin ZC,Deng XX,et al.Clinical efficacy of antibiotic bone cement combined with vacuum sealing drainage in treating diabetes mellitus complicated with necrotizing fasciitis[J].Chin J Burns Wounds,2023,39(12):1158-1162.DOI: 10.3760/cma.j.cn501225-20231030-00151.
Citation: Guo XF,Jin ZC,Deng XX,et al.Clinical efficacy of antibiotic bone cement combined with vacuum sealing drainage in treating diabetes mellitus complicated with necrotizing fasciitis[J].Chin J Burns Wounds,2023,39(12):1158-1162.DOI: 10.3760/cma.j.cn501225-20231030-00151.
shu

Clinical efficacy of antibiotic bone cement combined with vacuum sealing drainage in treating diabetes mellitus complicated with necrotizing fasciitis

doi: 10.3760/cma.j.cn501225-20231030-00151

More Information
  • Corresponding author: Bu Fanyu, Email: bufanyu@163.com
  • Received Date: 2023-10-30
    Abstract
  •   Objective   To explore the clinical efficacy of antibiotic bone cement combined with vacuum sealing drainage (VSD) in treating diabetes mellitus complicated with necrotizing fasciitis.   Methods   The retrospective observational study approach was used. From January 2020 to March 2022, 12 patients with type 2 diabetes complicated with necrotizing fasciitis who met the inclusion criteria were admitted to Wuxi Ninth People's Hospital, including 7 males and 5 females, aged 27 to 76 years. The initial diagnosis of lesions was in the lower limbs. After admission, bedside incision and drainage were performed timely, and a sample of wound exudate was collected for microbial cultivation. At the same time, the comprehensive supportive treatment was performed. At stage Ⅰ, debridement was performed, and the skin and soft tissue defect area was 40 cm×15 cm to 80 cm×25 cm after debridement. The dead space was filled with bone cement containing gentamicin and vancomycin and VSD was performed. After there was no obvious infection on the wound, the antibiotic bone cement was removed and wound repair surgery was performed at stage Ⅱ. The times of debridement, amputation, infection control, wound treatment method and wound healing at stage Ⅱ, total hospitalization day, and recurrence of necrotizing fasciitis during follow-up after the stage Ⅱ surgery. At the last follow-up, the walking function of patients was evaluated according to the scoring standards of American Orthopedic Foot and Ankle Association (AOFAS).   Results   Eleven patients had wound infection control with one debridement surgery and did not undergo amputation surgery; one patient had significant foot gangrene, and the infection was controlled after one debridement and amputation of the gangrenous limb. Blood routine and infection indicators gradually returned to normal within 7 days after surgery. At stage Ⅱ, the wounds in 4 patients were sutured directly, the wounds in 6 patients were repaired with full-thickness inguinal skin graft, while the wounds in 2 patients were repaired with pedicled or tongue-shaped flaps at the wound edge. The wounds healed well after surgery, with no ulceration. The total hospitalization day of patients was 20 to 45 days. Follow-up for 3 to 24 months after stage Ⅱ surgery showed no recurrence of necrotizing fasciitis in any patient. At the last follow-up, the walking function was evaluated as excellent in 10 cases and good in 2 cases according to the AOFAS scoring standard.   Conclusions   Antibiotic bone cement combined with VSD used in treating type 2 diabetes complicated with necrotizing fasciitis can effectively control infection and reduce the times of debridement, with good wound healing and walking function after surgery.

     

    • FullText(HTML)
  • loading
    • References(23)
  • [1]
    LeibleinM, MarziI, SanderAL, et al. Necrotizing fasciitis: treatment concepts and clinical results[J].Eur J Trauma Emerg Surg, 2018,44(2):279-290. DOI: 10.1007/s00068-017-0792-8.
    [2]
    DiabJ, BannanA, PollittT. Necrotising fasciitis[J]. Br Med J, 2020,27(369):m1428. DOI: 10.1136/bmj.m1428.
    [3]
    KarnutaJ, FeatherallJ, LawrenzJ, et al. What demographic and clinical factors are associated with in-hospital mortality in patients with necrotizing fasciitis?[J]. Clin Orthop Relat Res, 2020,478(8):1770-1779. DOI: 10.1097/CORR.0000000000001187.
    [4]
    HietbrinkF,BodeLG,RiddezL,et al.Triple diagnostics for early detection of ambivalent necrotizing fasciitis[J].World J Emerg Surg,2016,11:51.DOI: 10.1186/s13017-016-0108-z.
    [5]
    GohT,GohLG,AngCH,et al.Early diagnosis of necrotizing fasciitis[J].Br J Surg,2014,101(1):e119-125.DOI: 10.1002/bjs.9371.
    [6]
    SahuKK,MishraAK,LopezCA.Necrotizing fasciitis: challenges in diagnosis and management[J].QJM,2020,113(3):220-221.DOI: 10.1093/qjmed/hcz163.
    [7]
    YildizH,YombiJC.Necrotizing soft-tissue infections[J].N Engl J Med,2018,378(10):970.DOI: 10.1056/NEJMc1800049.
    [8]
    McHenryCR,PiotrowskiJJ,PetrinicD,et al.Determinants of mortality for necrotizing soft-tissue infections[J].Ann Surg,1995,221(5):558-563; discussion 563-565.DOI: 10.1097/00000658-199505000-00013.
    [9]
    MadubaCC,NnadozieUU.Breast necrotizing fasciitis following stillbirth managed with nipple areola conservation in a resource-poor setting: a case report[J].J Surg Case Rep,2020,2020(2):rjz397.DOI: 10.1093/jscr/rjz397.
    [10]
    IacopiE,CoppelliA,GorettiC,et al.Necrotizing fasciitis and the diabetic foot[J].Int J Low Extrem Wounds,2015,14(4):316-327.DOI: 10.1177/1534734615606534.
    [11]
    曹涛,计鹏,张智,等.抗生素骨水泥治疗糖尿病足溃疡的前瞻性随机对照研究[J].中华烧伤与创面修复杂志,2023,39(4):311-318.DOI: 10.3760/cma.j.cn501225-20221111-00485.
    [12]
    陈伟, 常树森, 周健, 等. 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 [J]. 中华烧伤与创面修复杂志, 2023, 39(4): 319-324. DOI: 10.3760/cma.j.cn501225-20220628-00267.
    [13]
    AhnJ,RaspovicKM,LiuGT,et al.Lower extremity necrotizing fasciitis in diabetic and nondiabetic patients: mortality and amputation[J].Int J Low Extrem Wounds,2019,18(2):114-121.DOI: 10.1177/1534734619836464.
    [14]
    ZhangZ,LiuP,YangB,et al.Necrotizing fasciitis caused by diabetic foot[J].Int J Infect Dis,2021,103:3-5.DOI: 10.1016/j.ijid.2020.11.132.
    [15]
    杨少玲,韩瑞,胡丽叶.糖尿病足坏死性筋膜炎病理生理机制及诊治[J/CD].中华损伤与修复杂志(电子版),2020,15(5):392-396.DOI: 10.3877/cma.j.issn.1673-9450.2020.05.012.
    [16]
    MarkakisK,BowlingFL,BoultonAJ.The diabetic foot in 2015: an overview[J].Diabetes Metab Res Rev,2016,32 Suppl 1:S169-178.DOI: 10.1002/dmrr.2740.
    [17]
    ArosiI,HinerG,RajbhandariS.Pathogenesis and treatment of callus in the diabetic foot[J].Curr Diabetes Rev,2016,12(3):179-183.DOI: 10.2174/1573399811666150609160219.
    [18]
    邱旭升,陈一心,戚晓阳,等.诱导膜技术治疗感染性骨缺损的疗效分析[J].中国修复重建外科杂志,2017,31(9):1064-1068.DOI: 10.7507/1002-1892.201704002.
    [19]
    WangX,WangZ,FuJ,et al.Induced membrane technique for the treatment of chronic hematogenous tibia osteomyelitis[J].BMC Musculoskelet Disord,2017,18(1):33.DOI: 10.1186/s12891-017-1395-6.
    [20]
    BistolfiA,FerraciniR,AlbaneseC,et al.PMMA-based bone cements and the problem of joint arthroplasty infections: status and new perspectives[J].Materials (Basel),2019,12(23):4002.DOI: 10.3390/ma12234002.
    [21]
    SavvidouOD,KaspirisA,TrikoupisI,et al.Efficacy of antimicrobial coated orthopaedic implants on the prevention of periprosthetic infections: a systematic review and meta-analysis[J].J Bone Jt Infect,2020,5(4):212-222.DOI: 10.7150/jbji.44839.
    [22]
    MorelliI,DragoL,GeorgeDA,et al.Masquelet technique: myth or reality? A systematic review and meta-analysis[J].Injury,2016,47 Suppl 6:S68-76.DOI: 10.1016/S0020-1383(16)30842-7.
    [23]
    SeligsonD,BerlingS.Antibiotic-laden PMMA bead chains for the prevention of infection in compound fractures: current state of the art[J].Eur J Orthop Surg Traumatol,2015,25(6):969-974.DOI: 10.1007/s00590-015-1652-z.
    • 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(2)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (226) PDF downloads(74) 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