糖尿病足难治性溃疡实施网状中厚皮片移植联合改良VSD技术治疗的应用价值  

Application Value of Reticulated Medium-thickness Skin Graft Combined with Modified VSD Technique in the Treatment of Refractory Diabetic Foot Ulcer

作　　者：王雨辰 黄志敏 陈凯 WANG Yuchen;HUANG Zhimin;CHEN Kai(Fujian Provincial Hospital for Geriatrics,Fuzhou,Fujian Province,350000 China)

机构地区：[1]福建省老年医院,福建福州350000

出　　处：《糖尿病新世界》2022年第17期17-20,共4页Diabetes New World Magazine

摘　　要：目的 糖尿病足难治性溃疡应用网状中厚皮片移植联合改良负压封闭引流(vaccum sealing drainage,VSD)技术治疗的可行性。方法 选择2019年3月—2021年3月来福建省老年医院就诊的糖尿病足难治性溃疡患者150例,以1:1比例分布法分为对照组与观察组,各75例。对照组实施常规中厚皮片移植治疗,观察组实施网状中厚皮片移植联合改良VSD技术治疗,对比两组患者临床指标、溃疡愈合、肉芽组织生长情况、疼痛程度(Numerical Rating Scale,NRS)及瘢痕情况(Vancouver Scar Scale,VSS)评分。结果 观察组患者皮片存活率显著高于对照组,术后换药次数、创面愈合时间、住院时间、空腹血糖及餐后1 h血糖均低于对照组,差异有统计学意义(P<0.05);观察组患者治疗后2周和4周溃疡面积缩小率及肉芽组织覆盖率均显著高于对照组,差异有统计学意义(P<0.05);观察组患者治疗1个月及2个月后NRS及VSS评分均显著低于对照组,差异有统计学意义(P<0.05)。结论 网状中厚皮片移植联合改良VSD技术治疗糖尿病足难治性溃疡患者,治疗效果理想,可显著改善患者临床指标、溃疡愈合、肉芽组织生长情况,降低NRS及VSS评分。Objective To investigate the feasibility of reticulum-thickness skin grafting combined with improved vacuum sealing drainage(VSD) for the treatment of refractory diabetic foot ulcers.Methods A total of 150 patients with refractory diabetic foot ulcers who came to Fujian Geriatrics Hospital from March 2019 to March 2021 were selected,and divided into control group and observation group by 1:1 ratio distribution method,75 cases in each group.The patients in the control group were treated with conventional medium-thickness skin grafting,while the patients in the observation group were treated with mesh medium-thickness skin grafting combined with modified VSD technique.The clinical indicators,ulcer healing,granulation tissue growth,Numerical Rating Scale(NRS) and Vancouver Scar Scale(VSS) scores were compared between the two groups.Results The survival rate of skin grafts in the observation group was significantly higher than that in the control group,and the clinical indicators such as the number of dressing changes,wound healing time,hospital stay,fasting blood glucose and 1 h postprandial blood glucose were all lower than those in the control group,and the differences were statistically significant(P<0.05).The reduction rate of ulcer area and the growth of granulation tissue in the observation group were significantly higher than those in the control group at 2 and 4 weeks after treatment,and the difference was statistically significant(P<0.05).The NRS and VSS scores of the observation group after 1 month and 2 months of treatment were significantly lower than those of the control group,and the difference was statistically significant(P<0.05).Conclusion Mesh medium-thickness skin grafting combined with modified VSD technique in the treatment of patients with refractory diabetic foot ulcers has an ideal therapeutic effect.It can significantly improve the clinical indicators,ulcer healing,granulation tissue growth,and reduce NRS and VSS scores.

关 键 词：糖尿病足难治性溃疡 网状中厚皮片移植 VSD 溃疡愈合 肉芽组织生长 疼痛程度 瘢痕情况 

分 类 号：R658.3[医药卫生—外科学]