快速治愈顽固性糖尿病足溃疡并发骨外露的一种新治疗方法:暴露骨组织细胞然后移植表皮片

作     者：Yamaguchi Y. Yoshida S. Sumikawa Y. S. Itami 冯义国 

作者机构：Department of Dermatology Graduate School of Medicine Osaka University 2-2 Yamada-oka Suita-shi Osaka 5650871 Japan 

出 版 物：《世界核心医学期刊文摘（皮肤病学分册）》 (Digest of the World Core Medical JOurnals:Dermatology)

年 卷 期：2005年第1卷第4期

页      面：7-8页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：糖尿病足溃疡 骨外 骨组织 皮片 创面护理 慢性伤口 移植片 皮肤表皮 患骨 再移植 

摘      要：Background: Diabetic foot ulcers with exposed bones commonly result in amputation. Objectives: To determine whether exposure of bone marrow cells and subsequent grafting of epi dermal sheets accelerates healing and reduces the need for amputation. Methods: Thirty-eight patients with chronic wounds caused by diabetes mellitus were enrolled in this study. Epidermal sheets obtained from suction blisters of each patient were grafted on to diabetic foot ulcers without exposed bones (n=10) and were compared with the standard treatment of local wound care, debridement with a scalpel when indicated, bed rest and parenteral antibiotics (n=8). In another group of patients, diabetic wounds with exposed bones were treated either with the standard procedure (n=9) or with a newly developed experimental procedure(n=11). In that newprocedure, the affected bone was initially exposed by debridementwith a scalpel, followed by partial excision with a bone scraper until fresh bleeding was observed from the exposed bone. The lesions were then immediately covered with an occlusive dressing, and finally the wound was covered with an epidermal graft of skin harvested from suction blisters. Patients in each group were matchedwith their counterparts by age, sex, wound size, wound infection and wound duration, to compare the time needed for total skin repair and rates of amputation. Results: Epidermal grafting significantly accelerated the healing of diabetic foot ulcers (P=0.042) without exposed bones, with site-specific differentiation. The newly developed combination therapy resulted in the healing of all diabetic ulcers with exposed bones without the occurrence of osteomyelitis or the necessity for amputation (P 0.0001). Conclusions: Our study indicates that early aggressive debridement of diabetic foot ulcers with exposed bones down to a bleeding vascularized base and then grafting epidermal sheets significantly improves healing and reduces the rate of amputation.