Roselló Ruiz A
Hospital Universitario de Valme, Sevilla.
Rev Enferm. 1998 Oct;21(242):suppl 9-12.
Approximately 4.5% of the Spanish population suffer from Diabetes Mellitus (that means around 1.8 million people). Currently, the main problem that diabetes treatment presents is controlling its chronic complications, being the diabetic foot one of them, which can end up causing an amputation. Prevalence of ulceration varies according to sex, age and population characteristics, oscillating between 2.4% and 5.6%. In Catalonia, in a community case study, the prevalence was of 7.9%. In the same way, it has been calculated that at least 15% of diabetics will suffer from foot ulcerations during their lives.
A clinical case regarding a diabetic neuropathic chronic ulcer highly exuding was made to analyze the effect of this new dressing in the daily clinical practice. CombiDERM is an absorbent dressing with an external polyurethane plate and a central part with absorbent hydroparticles, indicated for the management of the exudate and the protection of the surrounding skin. 64-year-old woman, who suffered from Diabetes Mellitus type I to 28 years evolution with Retinopathy grade II, Artropathy of Charcott and a neuropathic ulcer of 4 years evolution. She was admitted in the Vascular Surgery Service the 6th of May of 1995 presenting an ulcer with signs of local infection in the sole of her left foot. Different local treatments were established and improvement periods were alternated with non-improvement periods, giving as a result an unfavorable evolution of the wound. The treatment with CombiDERM was established, using AQUACEL Ribbon (Hydrofiber dressing) as filling material. To evaluate the continuation of the treatment photos and acetates were taken, and data was registered in a Case Report Form.
At the beginning the ulcer presented a high level of exudate, no signs of infection, light pain and the skin surrounding the ulcer was lightly macerated. After nine days of treatment an improvement of the ulcer could be observed, with the presence of granulating tissue. On the twenty-fourth day, granulation in the bed of the wound was completed and the quantity of exudate had reduced significantly. Application and removal of the dressing was easy and without pain. The evolution of the lesion was very good, without signs of infection, and with a graded epithelization until the ulcer was completely healed, at the eleventh week of the treatment with the new dressing. (The surface of the ulcer decreased from 557.67 mm2 to 0 mm2).
Having in mind the good evolution of this ulcer and the characteristics of CombiDERM, the new dressing is an optimal alternative in the treatment of highly exuding diabetic neuropathy ulcers.
约4.5%的西班牙人口患有糖尿病（即约180万人）。目前，糖尿病治疗面临的主要问题是控制其慢性并发症，糖尿病足就是其中之一，最终可能导致截肢。溃疡的患病率因性别、年龄和人群特征而异，在2.4%至5.6%之间波动。在加泰罗尼亚的一项社区病例研究中，患病率为7.9%。同样，据计算，至少15%的糖尿病患者在其一生中会患足部溃疡。
以一例糖尿病神经性慢性高渗性溃疡的临床病例分析这种新型敷料在日常临床实践中的效果。CombiDERM是一种吸收性敷料，有外部聚氨酯板和中央含吸收性水颗粒的部分，用于处理渗出液和保护周围皮肤。一名64岁女性，患I型糖尿病28年，有II级视网膜病变、夏科关节病和4年病程的神经性溃疡。1995年5月6日入住血管外科，左足底有一个伴有局部感染迹象的溃疡。采用了不同的局部治疗方法，病情改善期与无改善期交替出现，导致伤口愈合情况不佳。采用CombiDERM进行治疗，使用AQUACEL Ribbon（水凝胶敷料）作为填充材料。为评估治疗的持续情况，拍摄了照片和醋酸盐照片，并将数据记录在病例报告表中。
起初，溃疡渗出液较多，无感染迹象，轻度疼痛，溃疡周围皮肤轻度浸渍。治疗九天后，可观察到溃疡有所改善，有肉芽组织形成。第24天，伤口床的肉芽组织形成完成，渗出液量显著减少。敷料的应用和去除操作简便且无痛。病变进展良好，无感染迹象，直至使用新型敷料治疗第11周溃疡完全愈合时，上皮化呈渐进性。（溃疡面积从557.67平方毫米降至0平方毫米）。
鉴于该溃疡的良好愈合情况以及CombiDERM的特性，这种新型敷料是治疗高渗性糖尿病神经病变溃疡的最佳选择。
