隐神经营养血管皮瓣在糖尿病足部溃疡的临床应用
The Saphenous neurocutaneous vascular flap in the clinical application of diabetic foot ulcers
目的 探讨应用隐神经营养血管皮瓣修复糖尿病足部溃疡的临床疗效。 方法 2010年9月~2016年9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隐神经营养血管皮瓣修复35例共36足。 结果 术后皮瓣血运良好,创面愈合良好,无皮瓣坏死。所有病例随访3~12个月,皮瓣质地优良,成活良好,耐磨压,大部分患者可恢复保护性感觉,患足可行走,功能恢复满意。 结论 应用隐神经营养血管皮瓣修复糖尿病足部溃疡临床效果良好,可缩短患者病程,其手术操作简单,易推广,能有效地改善患者生活质量,降低致残率。
Objective To investigate the clinical efficacy of the saphenous neurocutaneous vascular flap in diabetic foot ulcers. Methods From September 2010 to September 2016, 35 patients with 36 diabetic foot complicated with Wagner grade 2 or more foot ulcers were treated with saphenous neurocutaneous vascular flaps. Results The flaps had good blood supply, good wound healing and no necrosis. All patients were followed up for 3~12 months. The flaps were of good texture, good survival, tolerance to pressure, and most of the patients could recover the protective sensation. The foot could walk, and the function recovered satisfactorily. Conclusion The application of the saphenous neurocutaneous vascular flap for the diabetic foot ulcer has good clinical effecacy and can shorten the course of the disease. The operation, being simple and easy to popularize, can effectively improve the quality of life of patients and reduce the disability rate.
隐神经营养血管皮瓣 / 糖尿病足 / 溃疡 / 显微外科手术
Saphenous neurocutaneous vascular flap / Diabetic foot / Ulcer / Microsurgery
[1] Jiang Y, Ran X, Jia L, et al. Epidemiology of type 2 diabetic foot problems and predictive factors for amputation in China[J]. Int J Low Extrem Wounds, 2015,14(1): 19 -27.
[2] 冉兴无,杨兵全,许樟荣. 我国糖尿病足病的诊治现状与未来的研究方向[J]. 中华糖尿病杂志,2014,6(7): 437-439.
[3] 许蕾, 钱泓洁, 张杉杉, 等. 不同程度感染的糖尿病足溃疡患者临床特点及预后分析[J]. 中华内分泌代谢杂志, 2013, 29(2): 116-119.
[4] Lipsky BA, Berendt AR, Cornia PB, et al. 2012 Infectious diseases society of america clinical practice guideline for the diagnosis and treatment of diabetic foot infections[J]. Clin Infect Dis, 2012, 54(12): e132-e173.
[5] Bakker K,Apelqvist J,Schaper NC. Practical guidelines on the management and prevention of the diabetic foot 2011[J]. Diabetes Metab Res Rev,2012,28(Suppl 1):225-231.
[6] Sajid MT,Mustafa Qu,Shaheen N,et al. Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers[J]. J Coll Physicians Surg Pak,2015, 25(11):789-793.
[7] Ghanassia E, Villon L, Thuan Dit Dieudonné JF,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.
[8] Wu SC, Driver VR, Wrobel JS,et a1. Foot ulcers in the diabetic patient,prevention and treatment[J]. Vasc Health Risk Manag,2007,3(1):65-76.
[9] 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.
[10] 钟世镇,徐永清,周长满.皮神经营养血管皮瓣解剖基础及命名[J].中华显微外科杂志,1999,22(1):37-39.
[11]Stevanovi? G,Djordjevi? B, Dakovi? M,et a1.Fasciocutaneous perforators of the lower leg-anatomic study and clinical significance[J].Vojnosanit Pregl,2010, 67(2): 136-144.
[12]杨亚东,周娟,唐文,等. 内踝上皮支皮瓣在糖尿病足部溃疡的临床应用[J].中国临床解剖学杂志,2017,35(4): 441-444.
2017年江西省卫生计生委科技计划课题(20171107);2016年赣州市卫生计生委科技计划项目(2016-2-5)
/
〈 |
|
〉 |