Bingol Ugur A, Cinar Can, Arslan Hakan, Altındas Muzaffer
Department of Plastic, Reconstructive and Aesthetic Surgery, Yeditepe Medical School, Yeditepe University, Devlet Yolu Ankara Caddesi No. 102-104, Kozyatağı, 34752 Istanbul, Turkey.
Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul University Cerrahpasa Faculty of Medicine, 34098 Istanbul, Turkey.
Biomed Res Int. 2015;2015:785819. doi: 10.1155/2015/785819. Epub 2015 Sep 21.
Currently, free flaps and pedicled flaps are the first treatment choices for large heel ulcer reconstruction. However, flap reconstruction of heel ulcerations cannot be performed in all diabetics especially with concurrent severe peripheral vascular disease because of higher flap failure rate. In recent years, the use of acellular dermal matrix (ADM) has emerged as an alternative treatment option for extremity ulcers.
We present 13 diabetic patients with a large heel ulceration exposing the calcaneus, who were not eligible for flap surgery due to the presence of only one patent artery of trifurcation. These cases were treated with the vacuum assisted sandwich dermal matrix (VASDEM) method.
None of the patients required amputation. Skin grafting was successful in ten patients. Although partial losses were observed in three patients, they were healed spontaneously without surgical interventions. During the follow-up period none of the patients developed ulceration on the treatment area. All patients maintained their preoperative ambulatory ability.
VASDEM is a novel method offering opportunity for treatment before proceeding to amputation in diabetic heel ulceration exposing the calcaneus which is not suitable for flap surgery. It also has the potential to close wounds of all sizes independent of the vessel status and wound size in selected diabetic patients.
目前，游离皮瓣和带蒂皮瓣是足跟大溃疡重建的首选治疗方法。然而，由于皮瓣失败率较高，并非所有糖尿病患者，尤其是合并严重外周血管疾病的患者都能进行足跟溃疡的皮瓣重建。近年来，脱细胞真皮基质（ADM）的应用已成为治疗肢体溃疡的一种替代选择。
我们报告了13例足跟大溃疡并暴露跟骨的糖尿病患者，由于仅存在一条三叉分支的通畅动脉，这些患者不符合皮瓣手术的条件。这些病例采用真空辅助夹心真皮基质（VASDEM）方法进行治疗。
所有患者均无需截肢。10例患者植皮成功。虽然3例患者出现部分组织缺损，但未经手术干预均自行愈合。在随访期间，所有患者治疗区域均未发生溃疡。所有患者均保持了术前的行走能力。
VASDEM是一种新的方法，为不适合皮瓣手术、足跟溃疡并暴露跟骨的糖尿病患者提供了截肢前的治疗机会。它还有潜力闭合所有大小的伤口，而不受所选糖尿病患者血管状况和伤口大小的影响。
