Objective: To summarize the effectiveness and experience of Wanger grade 3-5 diabetic foot treated with vacuum sealing drainage (VSD) combined with transverse tibial bone transport.
Methods: Between March 2015 and January 2018, 21 patients with refractory diabetic foot who failed conservative treatment were treated with VSD combined with transverse tibial bone transport. There were 15 males and 6 females, aged 55-88 years (mean, 65 years). The diabetes history was 8-15 years (mean, 12.2 years). The duration of diabetic foot ranged from 7 to 84 days (mean, 35.3 days). The size of diabetic foot ulcer before operation ranged from 2 cm×2 cm to 8 cm×5 cm. According to Wanger classification, 8 cases were rated as grade 3, 11 cases as grade 4, and 2 cases as grade 5. Among the 21 cases, angiography of lower extremity before operation was performed in 5 cases, CT angiography of lower extremity in 16 cases, all of which indicated that the arteries below the knee were narrowed to varying degrees and not completely blocked. Preoperative foot skin temperature was (29.28±0.77)℃, C-reactive protein was (38.03±31.23) mg/L, leukocyte count was (9.44±2.21)×10 9/L, and the visual analogue scale (VAS) score was 6.8±1.5, and ability of daily living (Barthel index) was 54.3±10.3.
Results: After operation, 2 patients with Wanger grade 4 and smoking history failed treatment and had an major amputation (amputation above ankle joint) at 30 days and 45 days after operation, respectively. One patient with Wanger grade 5 and chronic heart failure died of cardiac arrest at 60 days after operation. The remaining 18 patients were followed up 6-24 months (mean, 9.2 months). The external fixator was removed at 40-62 days after operation, with an average of 46 days. All the wounds healed, with a healing time of 50-120 days (mean, 62.5 days). The pain of 18 patients' feet was relieved obviously, and there was no recurrence of ulcer in situ or other parts. There was no complication such as tibial fracture and ischemic necrosis of lower leg skin after operation. After ulcer healing, the foot skin temperature was (30.86±0.80)℃, C-reactive protein was (22.90±18.42) mg/L, VAS score was 2.4±1.2, and Barthel index was 77.3±4.6, all showing significant differences when compared with preoperative ones ( P<0.05); the leukocyte count was (8.91±1.72)×10 9/L, showing no significant difference ( t=1.090, P=0.291).
Conclusion: VSD combined with transverse tibial bone transport can effectively promote the healing of Wanger grade 3-5 diabetic foot wounds, but smokers, unstable blood glucose control, and chronic heart failure patients have the risk of failure.
目的: 总结采用封闭式负压引流（vaccum sealing drainage，VSD）联合胫骨横向骨搬移术治疗 Wanger 3～5 级难治性糖尿病足的疗效。.
方法: 2015 年 3 月—2018 年 1 月，采用 VSD 联合胫骨横向骨搬移术治疗 21 例经保守治疗失败的难治性糖尿病足患者。其中男 15 例，女 6 例；年龄 55～88 岁，平均 65 岁。糖尿病病程 8～15 年，平均 12.2 年；糖尿病足病程 7～84 d，平均 35.3 d。术前糖尿病足溃疡范围为 2 cm×2 cm～8 cm×5 cm。按 Wanger 分级：3 级 8 例，4 级 11 例，5 级 2 例。5 例行下肢血管造影、16 例行下肢血管 CT 造影，均提示膝以下动脉不同程度狭窄，未完全堵塞。患足皮温（29.28±0.77）℃，C 反应蛋白（38.03±31.23）mg/L，白细胞计数（9.44±2.21）×10 9/L；疼痛视觉模拟评分（VAS）为（6.8±1.5）分，日常生活能力（Barthel 指数）为（54.3±10.3）分。.
结果: 术后 2 例 Wanger 4 级并有吸烟史患者治疗失败，分别于术后 30 d 及 45 d 行大截肢（踝关节以上截肢）；1 例 Wanger 5 级合并慢性心力衰竭患者术后 60 d 突发呼吸心跳停止而死亡。余 18 例患者均获随访，随访时间 6～24 个月，平均 9.2 个月。术后 40～62 d，平均 46 d 拆除外固定支架。创面均愈合，愈合时间 50～120 d，平均 62.5 d。18 例患足疼痛均明显缓解，均未见原位及其他部位溃疡复发。术后均未出现胫骨骨折及小腿皮肤缺血坏死等并发症。溃疡愈合后患足皮温为（30.86±0.80）℃，C 反应蛋白为（22.90±18.42）mg/L，VAS 评分为（2.4±1.2）分，Barthel 指数为（77.3±4.6）分，均较术前显著改善，差异有统计学意义（ P<0.05）；白细胞计数为（8.91±1.72）×10 9/L，与术前比较差异无统计学意义（ t=1.090， P=0.291）。.
结论: VSD 联合胫骨横向骨搬移术可有效促进 Wanger 3～5 级糖尿病足创面愈合，但吸烟者、血糖控制不佳者及合并慢性心力衰竭者存在失败风险。.
Keywords: Diabetic foot; Ilizarov technique; transverse tibial bone transport; vacuum sealing drainage; wound repair.