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目的探讨抗生素骨水泥联合螺旋桨皮瓣在修复糖尿病足踝部创面中的临床应用价值。方法回顾性分析2013年9月—2015年12月,应用万古霉素或妥布霉素骨水泥联合腓动脉穿支或胫后动脉穿支螺旋桨皮瓣修复糖尿病足踝部创面9例。其中男性6例,女性3例;年龄45~63岁,平均53.1岁。致伤原因:道路交通伤5例,重物压砸伤2例,机器伤1例,摔伤1例。其中7例伤口分泌物细菌培养为阳性,创面缺损范围:4.5cm×4.0cm~8.0cm×6.5cm。术前将患者血糖控制在空腹<7mmol/L,餐后2h<11mmol/L,使用足量敏感抗生素抗感染,待创面周围水肿基本消退,用手持多普勒超声进行穿支点定位并完成螺旋桨皮瓣设计。术中对创面进行彻底清创,按术前设计切取皮瓣,皮瓣旋转修复创面,在皮瓣下方感染严重的区域放置抗生素骨水泥条1~2根,术后2~3周拔出。皮瓣切取范围13.0cm×5.0cm~23.0cm×9.0cm,4例供区直接缝合,5例供区植皮修复。结果术中顺利完成皮瓣切取及创面修复,术后皮瓣均顺利成活,其中2例皮瓣远端部分坏死,经换药后愈合,供区切口Ⅰ期愈合。患者均获随访,随访时间6~21个月,平均11.1个月,所有皮瓣外形良好。结论抗生素骨水泥联合螺旋桨皮瓣是修复糖尿病足踝部创面的有效方法。
Objective To investigate the clinical value of antibiotic bone cement combined with propeller flap in repairing diabetic foot and ankle wound. Methods Retrospective analysis from September 2013 to December 2015, 9 cases of diabetic foot and ankle were repaired with vancomycin or tobramycin bone cement combined with peroneal artery perforator or posterior tibial artery. Including 6 males and 3 females; aged 45 to 63 years, mean 53.1 years old. Causes of injury: 5 cases of road traffic injuries, heavy crush injuries in 2 cases, 1 case of mechanical injury, falls in 1 case. Among them, 7 cases of wound secretions were positive for bacterial culture. The wound defect range was 4.5cm × 4.0cm ~ 8.0cm × 6.5cm. Preoperative blood glucose control in patients with fasting <7mmol / L, postprandial 2h <11mmol / L, the use of sufficient quantities of sensitive antibiotics anti-infective until the edema around the wound surface subsided, with handheld Doppler ultrasound to wear fulcrum positioning and complete propeller skin Flap design. During surgery, the wounds were completely debridement, and the skin flap was cut out according to the preoperative design. The flap was revolved to repair the wounds. 1-2 antibiotic bone cement strips were placed in the severely infected area under the flaps and pulled out 2 to 3 weeks after the operation. Skin flap range of 13.0cm × 5.0cm ~ 23.0cm × 9.0cm, 4 for direct suture for donor site, 5 for graft repair. Results Skin flap and wound repair were successfully performed. All the flaps survived successfully. Two of them were partially necrotic in the distal part and were healed after dressing change. All the patients were followed up for 6-21 months with an average of 11.1 months. All the flaps had good appearance. Conclusion Antibiotic cement combined with propeller flap is an effective method to repair wounds of ankle and foot of diabetic foot.