内踝上皮支皮瓣在糖尿病足部溃疡的临床应用
The medial supra-malleolus perforator flap for the clinical treatment of diabetic foot ulcers
目的 探讨应用内踝上皮支皮瓣修复糖尿病足部溃疡的临床疗效。 方法 2012年3月至2015年3月,在内科治疗控制血糖的基础上,对糖尿病足合并Wagner分级2级以上的足部溃疡采用内踝上皮支皮瓣修复32例共38足。 结果 术后皮瓣血运良好,2例皮瓣远端小面积坏死,经换药后治愈,l例半年后因糖尿病血糖控制不良,外伤后伤口不愈合再次发生溃疡,并出现糖尿病足坏疽,行截肢处理。本组病例随访2~18个月,皮瓣成活良好,质地优良,耐磨压,大部分恢复保护性感觉,患足可负重行走,功能恢复满意。 结论 应用内踝上皮支皮瓣修复糖尿病足部溃疡临床效果良好,手术操作简便易行,能有效的提高患者生活质量。
Objective To explore the clinical application of the supra-malleolus perforator flap for repair of diabetic foot ulcers.Methods From March 2012 to March 2015. There were 38 feet in 32 patients developed diabetic foot ulcers with at least wagner II grade. The first medical treatment was to control blood glucose, then the supra-malleolus perforator flap was adopted to repair diabetic foot ulcers.Results The flaps survived totally in 38 feet,and the distal partial necrosis and secondary free-skin grafting were further conducted in 2 cases. Thirty-two cases were followed-up for 2 to 18 months,the circulation,color and texture of the flaps were excellent.The appearance and function of ankle joints were good.Conclusion The supra-malleolus perforator flap has sufficient blood supply and a high survival rate;It is convenient in design,dissection and without sacrifice of major arteries. So,it is an effective method to repair diabetic foot ulcers. This method is effective in improving the quality of life of patients.
内踝上皮支皮瓣 /   /   / 糖尿病足 /   /   / 溃疡 /   /   / 显微外科手术
Medial malleolus flap;   / Diabetes;   / Ulcer;   / Microsurgery
[1] 温桂芬,李萍,邓丽,等. 下肢血管重建及皮瓣修复糖尿病足的术后处
理[J]. 中华显微外科杂志,2007, 30(5):391-393.
[2] Richard JL, Schuldiner S. Epidemiology of diabetic foot problems[J].
Rev Med Interne, 2008, 29(suppl 2):S222-S230.
[3] Nather A, Bee CS, Huak CY, et al.Epidemiology of diabetic foot problems and predictive factors for limb loss[J]. J Diabetes Complications, 2008, 22(2):77-82.
[4] Edouard G,Laetitia V,Jean-Francois T,et a1.Long term outcome and disability of diabetic patients hospitalized for diabetic foot ulcers: a 6.5 year follow-up study[J]. Diabetes Care, 2008,3l(7):1288-1292.
[5] Stephanie CW,Vickie RD,James SW,et a1. Foot ulcers in the diabetic patient,prevention and treatment[J]. Vase Health Risk Manag,2007,3(1):65-76.
[6] 杜冬,庄永青,傅小宽,等.糖尿病足的显微外科治疗[J].中华显微外科杂志 2006,29(6):429-431
[7] Lesens O, Desbiezz F, Vidal M,et al.Culture of per-wound bone specimens:a simplified approach for the medical management of diabetic foot osteomyelitis[J]. Clin Microbiol Infect, 2010, 17(2):285-291.
[8] 杨克勤.谭海涛.江建中,等.内踝上皮支皮瓣修复小腿下段及足踝部组织缺损[J].中华显微外科杂志,2010,33(3):236-237.
[9] 王培吉,周忠良.逆行岛状皮瓣或远端蒂皮瓣坏死的原因探讨及防治措施[J].中华显微外科杂志,2010,33(2):118-121.
江西省卫生计生委科技计划课题(20171107)
/
〈 |
|
〉 |