Lázaro-Martínez José Luis, Álvaro-Afonso Francisco Javier, Sevillano-Fernández David, García-Álvarez Yolanda, Sanz-Corbalan Irene, García-Morales Esther
Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain.
Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
J Clin Med. 2020 Dec 13;9(12):4032. doi: 10.3390/jcm9124032.
We aimed to evaluate the effects of ultrasound-assisted wound (UAW) debridement on cellular proliferation and dermal repair in complicated diabetic foot ulcers as compared to diabetic foot ulcers receiving surgical/sharp wound debridement. A randomized controlled trial was performed involving 51 outpatients with complicated diabetic foot ulcers that either received surgical debridement ( = 24) or UAW debridement ( = 27) every week during a six-week treatment period. Compared to patients receiving surgical debridement, patients treated with UAW debridement exhibited significantly improved cellular proliferation, as determined by CD31 staining, Masson's trichrome staining, and actin staining. Bacterial loads were significantly reduced in the UAW debridement group compared to the surgical group (UAW group 4.27 ± 0.37 day 0 to 2.11 ± 0.8 versus surgical group 4.66 ± 1.21 day 0 to 4.39 ± 1.24 day 42; = 0.01). Time to healing was also significantly lower ( = 0.04) in the UAW group (9.7 ± 3.8 weeks) compared to the surgical group (14.8 ± 12.3 weeks), but both groups had similar rates of patients that were healed after six months of follow-up (23 patients (85.1%) in the UAW group vs. 20 patients (83.3%) in the surgical group; = 0.856). We propose that UAW debridement could be an effective alternative when surgical debridement is not available or is contraindicated for use on patients with complicated diabetic foot ulcers.
我们旨在评估超声辅助伤口清创术（UAW）对复杂糖尿病足溃疡细胞增殖和真皮修复的影响，并与接受手术/锐器伤口清创术的糖尿病足溃疡进行比较。进行了一项随机对照试验，纳入51例患有复杂糖尿病足溃疡的门诊患者，在为期六周的治疗期间，这些患者每周接受手术清创术（n = 24）或UAW清创术（n = 27）。与接受手术清创术的患者相比，经UAW清创术治疗的患者通过CD31染色、Masson三色染色和肌动蛋白染色测定，细胞增殖显著改善。与手术组相比，UAW清创术组的细菌载量显著降低（UAW组：第0天4.27±0.37至第42天2.11±0.8；手术组：第0天4.66±1.21至第42天4.39±1.24；P = 0.01）。UAW组的愈合时间也显著低于手术组（P = 0.04）（UAW组为9.7±3.8周，手术组为14.8±12.3周），但两组在随访六个月后愈合的患者比例相似（UAW组23例患者（85.1%），手术组20例患者（83.3%）；P = 0.856）。我们认为，当手术清创不可行或对患有复杂糖尿病足溃疡的患者使用有禁忌时，UAW清创术可能是一种有效的替代方法。
