Department of Burn Surgery, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P.R. China.
Medical Cosmetology Department, Jiangxi Maternal and Child Health Hospital, Nanchang, P.R. China.
Adv Wound Care (New Rochelle). 2020 Dec;9(12):676-685. doi: 10.1089/wound.2018.0903. Epub 2019 Nov 19.
To explore the clinical efficacy and advantages of five-in-one comprehensive limb salvage technologies for the treatment of severe diabetic foot ulcer (DFU). Clinical data for 120 patients with severe DFU treated between January 2012 and December 2017 were analyzed retrospectively. The control group (48 cases) was treated with traditional therapies, including controlling blood sugar, improving microcirculation, preserving nerve function, and dressing changes, whereas the experimental group (72 cases) was treated with traditional therapy combined with additional techniques, such as early and thorough debridement, negative pressure wound therapy, revascularization, and skin graft or flap. Ankle-brachial index (ABI), transcutaneous oxygen pressure (TcPO), wound healing rate, healing time, ulcer recurrence rate, and amputation rate were recorded. Compared with the control group, the experimental group significantly improved wound healing rate (93.1% vs. 72.9%; < 0.01), decreased wound healing time (16.2 ± 5.4 days vs. 32.2 ± 7.8 days; < 0.05), reduced major limb amputation rate (1.4% vs. 10.4%, < 0.05), and ulcer recurrence rate (5.6% vs. 14.6%; < 0.05). There were no significant differences in amputation rate between experimental and control group (29.2% vs. 33.3%, = 0.628). After revascularization, the revascularization group showed significantly improved ABI (0.75 ± 0.21 vs. 0.35 ± 0.16, < 0.05) and TcPO (36 ± 6 mmHg vs. 15 ± 4 mmHg, < 0.05). We propose a five-in-one comprehensive treatment method, which provides a multidisciplinary cooperative model for comprehensive medical and surgical treatments for DFU. The five-in-one comprehensive limb salvage treatment technologies played a vital role in enhancing the healing rate of severe DFU, shortening the healing time, and reducing the rate of recurrence and major amputation, thus improving the overall quality of life.
探讨五合一综合保肢技术治疗严重糖尿病足溃疡（DFU）的临床疗效和优势。回顾性分析 2012 年 1 月至 2017 年 12 月收治的 120 例严重 DFU 患者的临床资料。对照组（48 例）采用控制血糖、改善微循环、保护神经功能、换药等传统疗法，实验组（72 例）采用传统疗法联合早期彻底清创、负压伤口治疗、血运重建、植皮或皮瓣等附加技术。记录踝肱指数（ABI）、经皮氧分压（TcPO）、创面愈合率、愈合时间、溃疡复发率和截肢率。与对照组相比，实验组创面愈合率显著提高（93.1%比 72.9%；<0.01），创面愈合时间缩短（16.2±5.4 天比 32.2±7.8 天；<0.05），大截肢率降低（1.4%比 10.4%；<0.05），溃疡复发率降低（5.6%比 14.6%；<0.05）。实验组和对照组的截肢率无显著差异（29.2%比 33.3%；=0.628）。血运重建后，血运重建组 ABI（0.75±0.21 比 0.35±0.16；<0.05）和 TcPO（36±6mmHg 比 15±4mmHg；<0.05）显著改善。我们提出了一种五合一的综合治疗方法，为 DFU 的综合内科和外科治疗提供了多学科合作模式。五合一综合保肢治疗技术在提高严重 DFU 的愈合率、缩短愈合时间、降低复发率和大截肢率方面发挥了重要作用，从而提高了整体生活质量。
