Eran Tamir, MD, is Senior Foot & Ankle Surgeon, Department of Orthopedics, Assaf HaRofeh Medical Center, Zerifin, Israel. Aharon S. Finestone, MD, is Orthopedic Surgeon, Assaf HaRofeh Medical Center, Zerifin, Israel. Itay Wiser, MD, is Lecturer, Department of Epidemiology, Sackler School of Medicine, Tel Aviv University, Israel. Yoram Anekstein, MD, is Head of the Spine Unit, Orthopedic Surgery Department, Assaf HaRofeh Medical Center, Zerifin, Israel. Gabriel Agar, MD, is Head of the Orthopedic Department, Assaf HaRofeh Medical Center, Zerifin, Israel.
Adv Skin Wound Care. 2018 Aug;31(8):365-369. doi: 10.1097/01.ASW.0000531352.93490.24.
To present results and complications in a case series of outpatients with diabetic and neuropathic foot ulcers with exposed bone following surgical debridement treated with negative-pressure wound therapy (NPWT).
Retrospective data were obtained from digital medical records from the Maccabi Health Services High Risk Foot Clinic in Tel Aviv, Israel, between 2009 and 2014. Medical records examined were those of clinic outpatients with exposed bone following partial foot amputation or selective bone debridement (University of Texas grade III-A) treated with NPWT.
Wound area, closure rate, and adverse events.
There were 66 patients provided NPWT in a total of 77 treatment courses. Mean patient age was 62 ± 10 years, 82% were male, and mean diabetes mellitus duration was 14 ± 8 years. Mean HbA1C levels were 8.1% ± 1.7%. Mean treatment course duration was 16 days (range, 2-42 days). Wound area decreased significantly (from 11.3 ± 16.8 cm to 8.0 ± 13.3 cm, P < .0001). Ulcer curing was noted in 7% of the cases, and healing progression was noted in 54%. Seven serious adverse events were recorded.
Outpatient NPWT is a relatively safe and effective adjuvant to surgical debridement of neuropathic foot ulcers. In an outpatient setting, one can expect serious adverse events to occur in 10% of cases, but this seems unavoidable in patients with diabetic foot ulcers when taking into account their comorbidities and patient resources. Strict protocols to promote early recognition of complications and appropriate response to minimize deterioration must be implemented.
报告经手术清创后患有糖尿病和神经病变性足部溃疡伴骨外露的门诊患者采用负压伤口疗法（NPWT）治疗的结果和并发症。
回顾性数据来自于以色列特拉维夫的 Maccabi 医疗服务高风险足部诊所的数字病历，时间范围为 2009 年至 2014 年。检查的病历为接受 NPWT 治疗的经部分足部截肢或选择性骨清创术（德克萨斯大学 3A 级）治疗的门诊患者的骨外露。
伤口面积、闭合率和不良事件。
共有 66 例患者在 77 次治疗过程中接受 NPWT。患者平均年龄为 62±10 岁，82%为男性，平均糖尿病病程为 14±8 年，平均糖化血红蛋白水平为 8.1%±1.7%。平均治疗疗程为 16 天（范围为 2-42 天）。伤口面积显著减小（从 11.3±16.8cm 减小至 8.0±13.3cm，P＜0.0001）。7%的病例溃疡治愈，54%的病例愈合进展。记录到 7 例严重不良事件。
门诊 NPWT 是治疗神经病变性足部溃疡的一种相对安全有效的辅助方法。在门诊环境中，预计 10%的病例会发生严重不良事件，但考虑到糖尿病足溃疡患者的合并症和患者资源，这似乎是不可避免的。必须实施严格的方案以促进早期识别并发症，并采取适当的措施来最小化病情恶化。
