Dong Shunan, Huang Dong, Zhu Lilin, Liu Xiaoyan
Department of Traumatology and Orthopedics, Second People's Hospital of Guangdong Province, Guangzhou Guangdong, 510317, P.R.China;Graduate School of Guangdong Medical University, Zhanjiang Guangdong, 524000, P.R.China.
Graduate School of Guangdong Medical University, Zhanjiang Guangdong, 524000, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Jul 15;34(7):869-873. doi: 10.7507/1002-1892.201911150.
To summarize the effectiveness and experience of Wanger grade 3-5 diabetic foot treated with vacuum sealing drainage (VSD) combined with transverse tibial bone transport.
Between March 2015 and January 2018, 21 patients with refractory diabetic foot who failed conservative treatment were treated with VSD combined with transverse tibial bone transport. There were 15 males and 6 females, aged 55-88 years (mean, 65 years). The diabetes history was 8-15 years (mean, 12.2 years). The duration of diabetic foot ranged from 7 to 84 days (mean, 35.3 days). The size of diabetic foot ulcer before operation ranged from 2 cm×2 cm to 8 cm×5 cm. According to Wanger classification, 8 cases were rated as grade 3, 11 cases as grade 4, and 2 cases as grade 5. Among the 21 cases, angiography of lower extremity before operation was performed in 5 cases, CT angiography of lower extremity in 16 cases, all of which indicated that the arteries below the knee were narrowed to varying degrees and not completely blocked. Preoperative foot skin temperature was (29.28±0.77)℃, C-reactive protein was (38.03±31.23) mg/L, leukocyte count was (9.44±2.21)×10 /L, and the visual analogue scale (VAS) score was 6.8±1.5, and ability of daily living (Barthel index) was 54.3±10.3.
After operation, 2 patients with Wanger grade 4 and smoking history failed treatment and had an major amputation (amputation above ankle joint) at 30 days and 45 days after operation, respectively. One patient with Wanger grade 5 and chronic heart failure died of cardiac arrest at 60 days after operation. The remaining 18 patients were followed up 6-24 months (mean, 9.2 months). The external fixator was removed at 40-62 days after operation, with an average of 46 days. All the wounds healed, with a healing time of 50-120 days (mean, 62.5 days). The pain of 18 patients' feet was relieved obviously, and there was no recurrence of ulcer or other parts. There was no complication such as tibial fracture and ischemic necrosis of lower leg skin after operation. After ulcer healing, the foot skin temperature was (30.86±0.80)℃, C-reactive protein was (22.90±18.42) mg/L, VAS score was 2.4±1.2, and Barthel index was 77.3±4.6, all showing significant differences when compared with preoperative ones ( <0.05); the leukocyte count was (8.91±1.72)×10 /L, showing no significant difference ( =1.090, =0.291).
VSD combined with transverse tibial bone transport can effectively promote the healing of Wanger grade 3-5 diabetic foot wounds, but smokers, unstable blood glucose control, and chronic heart failure patients have the risk of failure.
总结封闭负压引流（VSD）联合胫骨横向骨搬运治疗Wagner 3-5级糖尿病足的疗效及经验。
2015年3月至2018年1月，对21例保守治疗失败的难治性糖尿病足患者采用VSD联合胫骨横向骨搬运治疗。其中男性15例，女性6例，年龄55-88岁（平均65岁）。糖尿病病史8-15年（平均12.2年）。糖尿病足病程7-84天（平均35.3天）。术前糖尿病足溃疡面积2 cm×2 cm至8 cm×5 cm。按Wagner分级，3级8例，4级11例，5级2例。21例中，术前5例行下肢血管造影，16例行下肢CT血管造影，均提示膝以下动脉不同程度狭窄但未完全闭塞。术前足部皮肤温度为（29.28±0.77）℃，C反应蛋白为（38.03±31.23）mg/L，白细胞计数为（9.44±2.21）×10⁹/L，视觉模拟评分（VAS）为6.8±1.5，日常生活能力（Barthel指数）为54.3±10.3。
术后，2例有吸烟史的Wagner 4级患者治疗失败，分别于术后30天和45天进行了大截肢（踝关节以上截肢）。1例Wagner 5级合并慢性心力衰竭患者于术后60天死于心脏骤停。其余18例患者随访6-24个月（平均9.2个月）。术后40-62天拆除外固定架，平均46天。所有创面均愈合，愈合时间50-120天（平均62.5天）。18例患者足部疼痛明显缓解，溃疡及其他部位无复发。术后无胫骨骨折、小腿皮肤缺血坏死等并发症。溃疡愈合后，足部皮肤温度为（30.86±0.80）℃，C反应蛋白为（22.90±18.42）mg/L，VAS评分为2.4±1.2，Barthel指数为77.3±4.6，与术前比较均有显著差异（P<0.05）；白细胞计数为（8.91±1.72）×10⁹/L，差异无统计学意义（P=1.090，P=0.291）。
VSD联合胫骨横向骨搬运能有效促进Wagner 3-5级糖尿病足创面愈合，但吸烟者、血糖控制不稳定及慢性心力衰竭患者有治疗失败的风险。
