Washington, D.C. From the Department of Plastic Surgery, Georgetown University Hospital.
Plast Reconstr Surg. 2011 Jan;127(1):260-267. doi: 10.1097/PRS.0b013e3181f95c4b.
The diabetic foot ulcer presents a therapeutic challenge with a high rate of limb infection and extremity amputation. Adequate debridement and stable coverage of exposed structures are paramount to preserving limb length. The authors reviewed their use of a collagen bilayer matrix in the diabetic population for the preservation of functional limb length. Salvage rates were stratified with patient comorbidities of severe peripheral arterial disease and/or persistent infection.
A retrospective review was performed of all consecutive patients who underwent application of Integra by the senior authors (J.S.S., C.E.A.) for lower extremity salvage between January of 2004 and December of 2008.
A total of 105 patients with 121 separate wounds were analyzed. Patient age ranged from 22 to 80 years (mean, 58 years). The average wound size was 25.9 cm2 in the diabetic population. Average follow-up was 325 days, and average number of operations before closure was 1.28. In the diabetic population, of the 59 patients identified as low risk for amputation, 10 (17 percent) progressed to amputation. Of the 28 patients identified as high risk for amputation, 15 (54 percent) progressed to amputation. In the nondiabetics, 31 patients were classified as low risk for amputation, and one (3 percent) went on to an amputation.
Use of a collagen bilayer matrix appears to be a viable option for reconstruction and stable closure in the diabetic patient at low risk for amputation, with risk based on available blood supply and evidence of infection. In the diabetic patient at high risk for amputation, however, the rate of salvage may not be improved with the use of Integra.
糖尿病足溃疡的治疗具有挑战性，其肢体感染和截肢率很高。充分清创和稳定覆盖外露结构对于保持肢体长度至关重要。作者回顾了他们在糖尿病患者中使用双层胶原基质来保留功能性肢体长度的情况。根据患者严重外周动脉疾病和/或持续感染的合并症对挽救率进行分层。
对 2004 年 1 月至 2008 年 12 月期间，由高级作者（J.S.S.，C.E.A.）应用 Integra 进行下肢挽救的所有连续患者进行回顾性分析。
共分析了 105 例 121 处单独伤口的患者。患者年龄为 22 至 80 岁（平均 58 岁）。糖尿病患者的平均伤口大小为 25.9cm2。平均随访时间为 325 天，闭合前的平均手术次数为 1.28 次。在糖尿病患者中，59 例被认为低截肢风险的患者中有 10 例（17%）进展为截肢。28 例被认为高截肢风险的患者中有 15 例（54%）进展为截肢。在非糖尿病患者中，31 例被认为低截肢风险，其中 1 例（3%）进行了截肢。
在低截肢风险的糖尿病患者中，使用双层胶原基质似乎是一种可行的重建和稳定闭合选择，风险取决于可用的血液供应和感染证据。然而，对于高截肢风险的糖尿病患者，使用 Integra 可能无法提高挽救率。
