脱细胞同种异体真皮联合自体皮修复糖尿病足创面的临床效果

doi:10.3877/cma.j.issn.1673-9450.2024.01.009

目的

探讨脱细胞同种异体真皮(HADM)联合自体皮复合移植修复糖尿病足创面的临床效果。

方法

收集2020年12月至2022年7月，重庆医科大学附属璧山医院创面修复与烧伤科收治的7例Wager 4级糖尿病足患者资料，其中男4例，女3例；年龄68～82岁(平均74.5岁)，创面面积12 cm×7 cm～16 cm×12cm。病程6个月～2年，平均13个月。所有病例均行HADM联合自体皮复合移植修复创面。分别于术后7～10 d观察植皮区皮片色泽、存活面积，统计植皮成活率、再手术率、不良反应，评估患者创面愈合情况。

结果

7例患者随访时间1个月～ 2年(平均7个月)。平均愈合时间为9 d，再手术率为0，皮片存活率为95%～100%，植皮区未见明显色沉及萎缩。术后植皮区均成活，无再手术病例，无不良反应，患者均治愈、未复发。

结论

针对糖尿病足的大面积皮肤软组织破溃，应用HADM联合自体皮复合移植修复，其手术操作简便，术后植皮区成活率高，无复发，修复效果良好。

关键词: 糖尿病足, 脱细胞真皮, 创面修复

Objective

To investigate the clinical efficacy of combining human acellular demal mantrix (HADM) with autologous skin transplantation in repairing of diabetic foot wounds.

Methods

The data of seven patients with Wagre grade 4 diabetic foot, who were admitted to the Department of Wound Repair and Burns, Bishan Hospital Affiliated to Chongqing Medical University from December 2020 to July 2022, were collected. The patient cohort consisted of four males and three females, aged between 68 and 82 years (average age 74.5 years), with wound areas ranging from 12 cm ×7 cm to 16 cm×12 cm. The duration of the disease varied from 6 months to 2 years, with an average duration of 13 months. All cases underwent HADM combined with autologous skin transplantation for repair purposes. Skin color and survival area of the graft were assessed between 7 and 10 days post-operation, while the survival rate, reoperation rate, and adverse reactions associated with the skin graft were recorded.

Results

The follow-up period for 7 patients ranged from 1 month to 2 years, with a mean duration of 7 months. The average healing time was 9 days, with a reoperation rate of 0. All skin grafts exhibited complete survival without any cases requiring reoperation or adverse reactions, resulting in successful cure and no recurrence. The skin grafts demonstrated a high survival rate ranging from 95% to 100%, and there were no noticeable pigmentation or atrophy observed in the grafted area.

Conclusion

For the large area of skin and soft tissue rupture of diabetic foot, the application of HADM combined with autologous skin composite transplantation has simple operation, high survival rate of postoperative skin graft area, no recurrence, and good repair effect.

Key words: Diabetic foot, Acellularw dermis, Wound repair

图1 典型病例1。患者男，68岁。因右足溃烂2周就诊。A、B示术前右足创面；C示植皮前15 cm×10 cm缺损创面；D示术后即刻；E示术后1月随访情况；F示术后18个月随访情况

图2 典型病例2。患者男，81岁，因右足溃烂2个月就诊。A、B示术前右足创面；C示植皮前13 cm×8 cm缺损创面；D示术后即刻；E示术后1个月随访情况；F示术后3个月随访情况

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Clinical effect of acellular allograft dermis combined with autologous skin in repairing diabetic foot wound

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Clinical effect of acellular allograft dermis combined with autologous skin in repairing diabetic foot wound