Armenio Andrea, Cutrignelli Daniela Anna, Nardulli Maria Luisa, Maggio Giulio, Memeo Giuseppe, De Santis Valerio, Giudice Giuseppe, Ressa Cosmo Maurizio
Ann Ital Chir. 2017;88:268-274.
The aim of the study is to compare the standard care for progressive necrotizing infection in diabetic foot with a treatment protocol based on the association between autologous fibroblast grafts and vacuum-assisted closure therapy (V.A.C.).
A retrospective matched Case-Control study was carried out on 20 patients with diabetic foot infection, 10 treated with the standard care and 10 with our new protocol. Inclusion criteria were: acute diabetic foot necrosis (Wagner III and IV), ulcer size (30 to 80 cm2), tendon and bone exposure. Success in the treatment was evaluated as: percentage of healing at the 20th week, time of healing, deambulation, recurrence and major amputation rate.
A 90% healing rate was observed after 20 weeks in the study group, compared to a 28.6% in the control group. The recurrence rate in the treated areas was 20% in the study group and 100% in the control group. None of the patients in either group required major amputations.
We achieved very promising results by associating autologous fibroblasts grafts and V.A.C. therapy, in comparison with standard care. V.A.C. therapy seems to improve the growth rate of the fibroblasts, probably by sealing the wound and providing a moist environment following the fibroblast graft. The improved neoangiogenesis of the neo-dermis could explain the reduced recurrence rate of the study group.
Despite the low number of patients involved and the retrospective nature of the analysis, this study showed a reliable, safe and cost-effective method of treating extensive infection in the diabetic foot.
Bio-Engineered Tissue, Diabetic foot, Fibroblast graft, V.A.C.
本研究旨在比较糖尿病足进行性坏死性感染的标准治疗与基于自体成纤维细胞移植和负压封闭引流疗法（V.A.C.）联合应用的治疗方案。
对20例糖尿病足感染患者进行了一项回顾性配对病例对照研究，其中10例接受标准治疗，10例采用我们的新方案。纳入标准为：急性糖尿病足坏死（Wagner III级和IV级）、溃疡面积（30至80平方厘米）、肌腱和骨质暴露。治疗成功的评估指标为：第20周时的愈合百分比、愈合时间、行走能力、复发率和大截肢率。
研究组在20周后观察到愈合率为90%，而对照组为28.6%。研究组治疗区域的复发率为20%，对照组为100%。两组均无患者需要进行大截肢。
与标准治疗相比，我们通过联合自体成纤维细胞移植和V.A.C.疗法取得了非常有前景的结果。V.A.C.疗法似乎能提高成纤维细胞的生长速度，可能是通过封闭伤口并在成纤维细胞移植后提供一个湿润的环境。新生真皮新生血管生成的改善可以解释研究组复发率降低的原因。
尽管参与研究的患者数量较少且分析具有回顾性，但本研究显示了一种治疗糖尿病足广泛感染的可靠、安全且具有成本效益的方法。
生物工程组织；糖尿病足；成纤维细胞移植；V.A.C.
