Eginton Mark T, Brown Kellie R, Seabrook Gary R, Towne Jonathan B, Cambria Robert A
Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Ann Vasc Surg. 2003 Nov;17(6):645-9. doi: 10.1007/s10016-003-0065-3. Epub 2003 Oct 13.
Optimal treatment for large diabetic foot wounds is ill defined. The purpose of this study was to compare the rate of wound healing with the Vacuum Assisted Closure device trade mark (VAC) to conventional moist dressings in the treatment of large diabetic foot wounds. Diabetics with significant soft tissue defects of the foot were considered for enrollment. Patients were randomized to receive either moist gauze dressings or VAC treatments for 2 weeks, after which they were treated with the alternative dressing for an additional 2 weeks. Wounds were photographed weekly and wound dimensions calculated in a blinded fashion with spatial analysis software. Percent change in wound dimensions were calculated and compared for each weekly assessment and over 2 weeks of therapy with each dressing type. Ten patients were enrolled in the trial, but two were lost to follow-up and two were withdrawn. Complete data were available for analysis on seven wounds in six patients. Average length, width, and depth of the wounds at initiation of the trial was 7.7, 3.5, and 3.1 cm, respectively. Only the wound depth was significantly decreased over the weeks of the trial to 1.2 cm ( p < 0.05). VAC dressings decreased the wound volume and depth significantly more than moist gauze dressings (59% vs. 0% and 49% vs. 8%, respectively). VAC dressings were associated with a decrease in all wound dimensions while wound length and width increased with moist dressings. In summary, over the first several weeks of therapy, VAC dressings decreased wound depth and volume more effectively than moist gauze dressings. Negative-pressure wound treatment may accelerate closure of large foot wounds in the diabetic patient.
目前对于大型糖尿病足伤口的最佳治疗方法尚无明确界定。本研究的目的是比较使用负压封闭引流装置（VAC）与传统湿性敷料治疗大型糖尿病足伤口的愈合率。患有足部明显软组织缺损的糖尿病患者被纳入研究。患者被随机分为两组，分别接受为期2周的湿纱布敷料或VAC治疗，之后再接受为期2周的另一种敷料治疗。每周对伤口进行拍照，并使用空间分析软件以盲法计算伤口尺寸。计算每次每周评估以及每种敷料类型治疗2周期间伤口尺寸的百分比变化并进行比较。该试验共纳入10名患者，但有2名失访，2名退出。6名患者的7处伤口有完整数据可供分析。试验开始时伤口的平均长度、宽度和深度分别为7.7厘米、3.5厘米和3.1厘米。在试验的数周内，只有伤口深度显著降低至1.2厘米（p<0.05）。VAC敷料比湿纱布敷料更显著地减少了伤口体积和深度（分别为59%对0%和49%对8%）。VAC敷料使所有伤口尺寸均减小，而湿纱布敷料则使伤口长度和宽度增加。总之，在治疗的最初几周，VAC敷料比湿纱布敷料更有效地减少了伤口深度和体积。负压伤口治疗可能会加速糖尿病患者大型足部伤口的愈合。
