Ahmed M E, Mohammed M S, Mahadi S I
Professor of Surgery, FRCSI Assistant professor, Department of Surgery, Faculty of Medicine, University of Khartoum.
Alfashir University.
J Wound Care. 2016 Nov 2;25(11):650-654. doi: 10.12968/jowc.2016.25.11.650.
The role of stitching in healing diabetic foot ulcers (DFUs) has little attention, with few reports published on the technique. This study aimed to report on the role of stitching in healing of neuropathic DFUs.
This comparative study was between patients with diabetes with neuropathic foot ulcers who had undergone wound stitching and those on conventional wound care. The study was carried in Jabir Abu Eliz Diabetic Center Khartoum (JADC) during between January 1 2011 and January 1 2013. All patients presented with neuropathic diabetic septic foot on the plantar aspect or extending up the leg were included. Initial surgical sharp debridement under intravenous broad spectrum antibiotics was performed and oral antibiotics were given 3 days later after the results of the bacterial culture were received. Regular wound debridement was performed with the aim of pairing the wound edges for stitching. Primary closure was performed when the wound was clean from any necrotic tissues and partial closure when the wound was still oozy to secure drainage and avoid splaying of the wound edges. All patients were using either crutches or wheel chair initially until any sepsis cleared and then proper off-loading by shoes purpose made in our centre.
A 160 patients with neuropathic DFUs that needed debridement and frequent dressing changes as outpatients were included. Both groups had the same tap water wound dressing either daily, every other day or every two days according to the wound progress. Absorbent dressings and negative pressure wound therapy (NPWT) were unavailable. Half of the patients (n=80) had debridement, frequent dressing change using tap water throughout the period of study (group 1) while the rest (n=80) in addition to wound debridement underwent stitching of their wounds (group 2). Complete healing was achieved in 46 patients in Group 1 (57.5%) compared with 19 patients (23%) in group 2 (p=0.001). The average number of dressings used was 19 in stitch group compared with 30 in the non-stitch group (p=0.000). The average duration of healing in stitch group was 2.9 months compared with 5.7 months in non-stitch group (p=0.000).
Stitching of neuropathic DFUs reduced the duration of wound healing and the frequency of wound dressing change.
缝合在糖尿病足溃疡（DFU）愈合中的作用很少受到关注，关于该技术的报道也很少。本研究旨在报告缝合在神经性DFU愈合中的作用。
本比较研究在接受伤口缝合的神经性足部溃疡糖尿病患者和接受传统伤口护理的患者之间进行。该研究于2011年1月1日至2013年1月1日在喀土穆的贾比尔·阿布·埃利兹糖尿病中心（JADC）开展。纳入所有足底出现神经性糖尿病感染性足部溃疡或溃疡向上延伸至腿部的患者。在静脉输注广谱抗生素的情况下进行初始手术锐性清创，并在收到细菌培养结果3天后给予口服抗生素。定期进行伤口清创，目的是使伤口边缘对合以便缝合。当伤口无任何坏死组织时进行一期缝合，当伤口仍有渗液时进行部分缝合以确保引流并避免伤口边缘裂开。所有患者最初均使用拐杖或轮椅，直至任何感染清除，然后使用我们中心特制的鞋子进行适当的减压。
纳入160例需要清创且作为门诊患者频繁更换敷料的神经性DFU患者。根据伤口进展情况，两组患者均每日、隔日或每两日使用相同的自来水伤口敷料。无法获得吸收性敷料和负压伤口治疗（NPWT）。一半患者（n = 80）在整个研究期间进行清创并频繁使用自来水更换敷料（第1组），而其余患者（n = 80）除伤口清创外还对伤口进行了缝合（第2组）。第1组46例患者（57.5%）实现完全愈合，而第2组为19例患者（23%）（p = 0.001）。缝合组使用的敷料平均数量为19次，而非缝合组为30次（p = 0.000）。缝合组的平均愈合时间为2.9个月，而非缝合组为5.7个月（p = 0.000）。
神经性DFU的缝合缩短了伤口愈合时间并减少了伤口换药频率。
