Bosanquet David C, Blow Melissa, Ashton Faye, Harding Keith
South East Wales Vascular Network, Aneurin Bevan University Health Board, Cwmbran, UK.
Leicester Biomedical Research Centre, Glenfield University Hospital, Leicester, UK.
Int J Low Extrem Wounds. 2025 Apr 27;24(3):15347346251331254. doi: 10.1177/15347346251331254.
ObjectiveTo measure the effect of neuromuscular stimulation of the common peroneal nerve on the microvascular blood flow within the wound bed of diabetic foot ulcers.Research Design and Methods13 patients with diabetic foot ulcers (11 neuropathic, 2 neuroischemic) were recruited. Microvascular flux and pulsatility were measured in real time in the wound bed, and at the wound edge, using Laser Speckle Contrast Imaging (Moor FLPI-2; Moor Instruments Ltd, Axminster, United Kingdom). Changes from baseline were measured when the leg muscle pump was activated by 1 Hz neuromuscular stimulation of the common peroneal nerve, using a wearable device (geko, Firstkind Ltd Daresbury, United Kingdom).ResultsIn the 11 neuropathic ulcers, significant increases were seen in all microvascular parameters. Wound bed flux increased by 36% (95%CI 11%-68%, = .002), and peri-wound flux increased by 92% (95%CI 46%-160%, = .001). Pulsatility in the wound bed increased by 183% (95%CI 61%-517%, = .005), while pulsatility in the peri-wound increases by 359% (95%CI 264%-455%, = .001). Additionally, an increase in flux and pulsatility was observed in the neuroischemic ulcers.ConclusionsNeuromuscular stimulation of the common peroneal nerve presents a mode of activating the leg muscle pump without additional pressure insult to the foot and has potential to support the microcirculation during wound-healing, effectively emulating exercise without any of the attendant risks of exercise to the neuropathic or neuroischemic foot.
目的
测量腓总神经的神经肌肉刺激对糖尿病足溃疡创面床微血管血流的影响。
研究设计与方法
招募了13例糖尿病足溃疡患者（11例神经病变型，2例神经缺血型）。使用激光散斑对比成像（Moor FLPI-2；Moor Instruments Ltd，英国埃克斯明斯特）在创面床和创缘实时测量微血管通量和搏动性。当使用可穿戴设备（geko，Firstkind Ltd，英国达雷斯伯里）通过1Hz的腓总神经神经肌肉刺激激活腿部肌肉泵时，测量相对于基线的变化。
结果
在11例神经病变型溃疡中，所有微血管参数均显著增加。创面床通量增加了36%（95%CI 11%-68%，P = 0.002），创面周围通量增加了92%（95%CI 46%-160%，P = 0.001）。创面床的搏动性增加了183%（95%CI 61%-517%，P = 0.005），而创面周围的搏动性增加了359%（95%CI 264%-455%，P = 0.001）。此外，在神经缺血型溃疡中也观察到通量和搏动性增加。
结论
腓总神经的神经肌肉刺激提供了一种激活腿部肌肉泵的方式，而不会对足部造成额外的压力损伤，并且在伤口愈合过程中有支持微循环的潜力，能有效模拟运动，而不会给神经病变或神经缺血性足部带来运动的相关风险。
