Guo X F, Jin Z C, Deng X X, Huang Z H, Xue M Y, Bu F Y
Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi. 2023 Dec 20;39(12):1158-1162. doi: 10.3760/cma.j.cn501225-20231030-00151.
To explore the clinical efficacy of antibiotic bone cement combined with vacuum sealing drainage (VSD) in treating diabetes mellitus complicated with necrotizing fasciitis. The retrospective observational study approach was used. From January 2020 to March 2022, 12 patients with type 2 diabetes complicated with necrotizing fasciitis who met the inclusion criteria were admitted to Wuxi Ninth People's Hospital, including 7 males and 5 females, aged 27 to 76 years. The initial diagnosis of lesions was in the lower limbs. After admission, bedside incision and drainage were performed timely, and a sample of wound exudate was collected for microbial cultivation. At the same time, the comprehensive supportive treatment was performed. At stage Ⅰ, debridement was performed, and the skin and soft tissue defect area was 40 cm×15 cm to 80 cm×25 cm after debridement. The dead space was filled with bone cement containing gentamicin and vancomycin and VSD was performed. After there was no obvious infection on the wound, the antibiotic bone cement was removed and wound repair surgery was performed at stage Ⅱ. The times of debridement, amputation, infection control, wound treatment method and wound healing at stage Ⅱ, total hospitalization day, and recurrence of necrotizing fasciitis during follow-up after the stage Ⅱ surgery. At the last follow-up, the walking function of patients was evaluated according to the scoring standards of American Orthopedic Foot and Ankle Association (AOFAS). Eleven patients had wound infection control with one debridement surgery and did not undergo amputation surgery; one patient had significant foot gangrene, and the infection was controlled after one debridement and amputation of the gangrenous limb. Blood routine and infection indicators gradually returned to normal within 7 days after surgery. At stage Ⅱ, the wounds in 4 patients were sutured directly, the wounds in 6 patients were repaired with full-thickness inguinal skin graft, while the wounds in 2 patients were repaired with pedicled or tongue-shaped flaps at the wound edge. The wounds healed well after surgery, with no ulceration. The total hospitalization day of patients was 20 to 45 days. Follow-up for 3 to 24 months after stage Ⅱ surgery showed no recurrence of necrotizing fasciitis in any patient. At the last follow-up, the walking function was evaluated as excellent in 10 cases and good in 2 cases according to the AOFAS scoring standard. Antibiotic bone cement combined with VSD used in treating type 2 diabetes complicated with necrotizing fasciitis can effectively control infection and reduce the times of debridement, with good wound healing and walking function after surgery.
探讨抗生素骨水泥联合封闭式负压引流（VSD）治疗糖尿病合并坏死性筋膜炎的临床疗效。采用回顾性观察研究方法。2020年1月至2022年3月，无锡市第九人民医院收治12例符合纳入标准的2型糖尿病合并坏死性筋膜炎患者，其中男性7例，女性5例，年龄27～76岁。病变初始诊断部位为下肢。入院后及时行床边切开引流，并采集伤口渗出物样本进行微生物培养。同时，进行综合支持治疗。Ⅰ期行清创术，清创后皮肤及软组织缺损面积为40cm×15cm至80cm×25cm。用含庆大霉素和万古霉素的骨水泥填充死腔，并进行VSD治疗。伤口无明显感染后，取出抗生素骨水泥，Ⅱ期行伤口修复手术。记录Ⅱ期清创次数、截肢情况、感染控制情况、伤口处理方法及愈合情况、总住院天数以及Ⅱ期手术后随访期间坏死性筋膜炎复发情况。末次随访时，根据美国足踝外科协会（AOFAS）评分标准评估患者行走功能。11例患者经1次清创手术控制伤口感染，未行截肢手术；1例患者足部坏疽严重，经1次清创及截肢坏疽肢体后感染得到控制。术后7天内血常规及感染指标逐渐恢复正常。Ⅱ期，4例患者伤口直接缝合，6例患者采用腹股沟全厚皮片修复伤口，2例患者采用伤口边缘带蒂皮瓣或舌形皮瓣修复伤口。术后伤口愈合良好，无溃疡形成。患者总住院天数为20～45天。Ⅱ期手术后随访3～24个月，所有患者均无坏死性筋膜炎复发。末次随访时，根据AOFAS评分标准，10例患者行走功能评定为优，2例患者评定为良。抗生素骨水泥联合VSD治疗2型糖尿病合并坏死性筋膜炎能有效控制感染，减少清创次数，术后伤口愈合及行走功能良好。
