外周动脉疾病对足跟压疮愈合的影响。
Influence of Peripheral Arterial Disease on Wound Healing in Heel Pressure Ulcers.
机构信息
Department of Plastic and Reconstructive Surgery, Kurashiki-Heisei General Hospital, Okayama, Japan.
Department of Plastic and Reconstructive Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
出版信息
Kobe J Med Sci. 2022 Feb 8;67(4):E146-E154.
BACKGROUND
There are cases of heel pressure ulcer with peripheral arterial disease (PAD). The influence of ischemia on wound healing was investigated.
METHODS
We retrospectively studied 253 patients with heel ulcers treated between January 2003 and March 2018. The patients were classified into PAD and non-PAD groups. The wound healing rate, wound healing time and the factors that influenced wound healing were examined.
RESULTS
There were 186 patients with PAD (73.5%). There were 41 (22.0%) and 35 (52.2%) wound healing cases with PAD and non-PAD, respectively (P < 0.001). In the non-PAD group, the deeper the ulcer, the lower the wound healing rate. However, in the PAD group, the increase in blood flow owing to revascularization affected the wound healing rate. The wound healing rate in the endovascular therapy (EVT) and bypass groups were 26.7% and 65.0%, respectively (P = 0.003). The wound healing time was 128 (interquartile range [IQR] 88－196) and 79 (IQR 35.5－187) days, with PAD and non-PAD, respectively (P = 0.0268). The wound healing time in the PAD group was 128 (IQR 93－174.5) days with bypass and 155.5 (IQR 86－237.5) days with EVT (P = 0.459).
CONCLUSIONS
Heel pressure ulcers with PAD are difficult to treat. The wound healing rate was lower in the PAD than in the non-PAD group and the wound healing time also tended to be long. Successful revascularization is important for wound healing and bypass surgery had a shorter wound healing time and a higher wound healing rate than EVT.
背景
有一些合并外周动脉疾病（PAD）的足跟压疮病例。本研究旨在探究缺血对伤口愈合的影响。
方法
回顾性分析 2003 年 1 月至 2018 年 3 月期间接受足跟溃疡治疗的 253 例患者。将患者分为 PAD 组和非 PAD 组。检查两组的伤口愈合率、伤口愈合时间以及影响伤口愈合的因素。
结果
253 例患者中，186 例（73.5%）合并 PAD。其中，PAD 组有 41 例（22.0%）和 35 例（52.2%）伤口愈合，非 PAD 组有 41 例（22.0%）和 35 例（52.2%）伤口愈合，差异具有统计学意义（P < 0.001）。非 PAD 组中，溃疡越深，愈合率越低。然而，在 PAD 组中，由于再血管化导致的血流增加影响了伤口愈合率。血管内治疗（EVT）和旁路组的愈合率分别为 26.7%和 65.0%（P = 0.003）。PAD 组和非 PAD 组的伤口愈合时间分别为 128（IQR 88-196）和 79（IQR 35.5-187）天，差异具有统计学意义（P = 0.0268）。PAD 组旁路手术的愈合时间为 128（IQR 93-174.5）天，EVT 为 155.5（IQR 86-237.5）天，差异无统计学意义（P = 0.459）。
结论
合并 PAD 的足跟压疮较难治疗。PAD 组的愈合率低于非 PAD 组，愈合时间也往往较长。成功的再血管化对伤口愈合很重要，旁路手术的伤口愈合时间更短，愈合率更高。
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