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透析患者糖尿病足溃疡的序贯治疗:一例报告

Sequential treatment for diabetic foot ulcers in dialysis patients: A case report.

作者信息

Wang Jin-Jun, Yu Yuan-Yuan, Wang Pin-Yi, Huang Xian-Ming, Chen Xiao, Chen Xi-Guang

机构信息

College of Marine Life Science, Ocean University of China, Qingdao 266003, Shandong Province, China.

Department of Vascular Surgery, Qingdao Haici Hospital Affiliated to Qingdao University, Qingdao 266033, Shandong Province, China.

出版信息

World J Diabetes. 2023 Aug 15;14(8):1323-1329. doi: 10.4239/wjd.v14.i8.1323.

Abstract

BACKGROUND

Diabetic foot ulcers (DFUs) are common in patients with diabetes, especially those undergoing hemodialysis. In severe cases, these ulcers can cause damage to the lower extremities and lead to amputation. Traditional treatments such as flap transposition and transfemoral amputation are not always applicable in all cases. Therefore, there is a need for alternative treatment methods.

CASE SUMMARY

This report describes a 62-year-old female patient who was admitted to the hospital with plantar and heel ulcers on her left foot. The patient had a history of renal failure and was undergoing regular hemodialysis. Digital subtraction angiography showed extensive stenosis and occlusion in the left superficial femoral artery, left peroneal artery and left posterior tibial artery. Following evaluation by a multidisciplinary team, the patient was diagnosed with type 2 DFUs (TEXAS 4D). Traditional treatments were deemed unsuitable, and the patient was treated with endovascular surgery in the affected area, in addition to supportive medical treatment, local debridement, and sequential repair using split-thickness skin and tissue-engineered skin grafts combined with negative pressure treatment. After four months, the wound had completely healed, and the patient was able to walk with a walking aid.

CONCLUSION

This study demonstrates a new treatment method for DFUs was successful, using angioplasty, skin grafts, and negative pressure.

摘要

背景

糖尿病足溃疡(DFUs)在糖尿病患者中很常见,尤其是那些正在接受血液透析的患者。在严重的情况下,这些溃疡会导致下肢损伤并导致截肢。传统治疗方法,如皮瓣转移和经股截肢,并非在所有情况下都适用。因此,需要替代治疗方法。

病例摘要

本报告描述了一名62岁女性患者,因左脚足底和足跟溃疡入院。该患者有肾衰竭病史,正在接受定期血液透析。数字减影血管造影显示左股浅动脉、左腓动脉和左胫后动脉广泛狭窄和闭塞。经过多学科团队评估,该患者被诊断为2型DFUs(德克萨斯4D)。传统治疗方法被认为不合适,除了支持性药物治疗、局部清创以及使用分层皮片和组织工程皮肤移植物结合负压治疗进行序贯修复外,还对该患者在患区进行了血管内手术治疗。四个月后,伤口完全愈合,患者能够借助助行器行走。

结论

本研究表明,一种使用血管成形术、皮肤移植和负压治疗DFUs的新治疗方法取得了成功。

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