| Objective:To investigate the clinical efficacy and value of advanced platelet-rich fibrin in the treatment of diabetic foot toe amputation wounds,and to provide a reasonable and effective solution for the treatment of diabetic foot toe amputation wounds.Methods:Patients who required inpatient toe amputation treatment in our burn and plastic surgery department due to diabetic foot disease between May 2022 and January 2023 were collected,and 50 patients were screened into the group strictly according to the inclusion and exclusion criteria,and they were divided into 25 cases each in the control group and the A-PRF group using the random number table method.Patients in both groups were admitted to hospital to complete the appropriate preoperative examination and preoperative preparation.After excluding contraindications to surgery,stage I surgery(toe amputation+debridement+NPWT treatment)was performed,and after 5-7 days of NPWT treatment,stage Ⅱ surgery was performed after fresh granulation of the wound.Patients in the control group were sutured directly after debridement,while patients in the A-PRF group had the cavity filled with A-PRF after debridement and then sutured.The following indicators were observed:1.Wound healing related indicators:(1)Wound healing time;(2)Grade A healing rate.2.Pain related indicators:(1)VAS pain score;(2)Number of times painkillers are used.3.Inflammatory indicators before and after treatment.4.Bacterial culture of wound secretions.5.Hospitalization costs.6.Occurrence of adverse events.7.Microscopic morphology of A-PRF.Results:1.General clinical data of patients in the two groupsThere were no statistical differences in gender(P=0.556>0.05),age(P=0.699>0.05),course of diabetes(P=0.550>0.05)and pre-treatment leukocytes(P=0.600>0.05),platelets(P=0.260>0.05)and C-reactive protein(P=0.677>0.05)between the two groups,and the two groups of patients were comparable.2.Wound healing-related indicators.(1)Wound healing timeThe healing time of the A-PRF group(10.48±2.82 days)was shorter than that of the control group(15.88±3.70 days),and the difference in healing time between the two groups was statistically significant(P=0.000<0.05).(2)Grade A healing rateIn the control group,there were 14 cases of Grade A healing,7 cases of Grade B healing and 4 cases of Grade C healing,with a Grade A healing rate of 56%.22 cases of Grade A healing and 3 cases of Grade B healing were found in the A-PRF group,with a Grade A healing rate of 88%.There was a statistically significant difference in the grade of healing(P=0.026<0.05)and grade A healing rate(P=0.027<0.05)between the two groups.3.Pain-related indicators.(1)VAS pain scoreThe VAS scores of the two groups of patients before,24 hours after and 72 hours after stage Ⅱ surgery were analysed separately.The VAS pain scores of the two groups before stage Ⅱ surgery(4.00±1.73 in the control group,4.28±1.59 in the A-PRF group)were not statistically different(P=0.555>0.05)and were comparable;24 hours after stage Ⅱ surgery(4.92±2.04 in the control group,3.80±1.58 in the A-PRF group)and 72 hours after stage Ⅱsurgery(3.80±1.52 in the control group,2.44±1.50 in the A-PRF group)VAS pain scores were lower in the A-PRF group than in the control group,and there was a statistical difference in VAS pain scores between the two groups(P=0.035<0.05,P=0.003<0.05).(2)Number of times painkillers are usedThe number of painkillers used within 7 days after stage Ⅱ surgery was recorded and analysed in both groups.The need for painkillers was less in the A-PRF group(4.12±2.24)than in the control group(6.36±2.86),and there was a statistical difference in the number of painkillers uses between the two groups(P=0.003<0.05).4.Inflammatory indicators before and after treatmentPatients in both groups had blood drawn and sent for testing on admission,before stageⅡ surgery and on day 7 after stage Ⅱ surgery.Both the control group and the A-PRF group showed significant improvement in inflammatory indexes after treatment(white blood cells(109/L):11.13±2.96 at the time of admission and 7.92±1.23 on day 7 after stage Ⅱ surgery in the control group,10.65±3.45 at the time of admission and 7.68±1.39 on day 7 after stageⅡ surgery in the A-PRF group;C-reactive protein(mg/L):51.41±54.41 at the time of admission and 9.33±1.51 on day 7 after stage Ⅱ surgery in the control group,55.39±56.39 at admission and 7.97±2.11 on day 7 after stage Ⅱ surgical in the A-PRF group),with a statistically significant difference in change(p<0.05).However,comparing the inflammatory indicators before stage Ⅱ surgery and on day 7 after stage Ⅱ surgery,no statistically significant difference was found between the groups(leukocytes P=0.735>0.05 and Creactive protein P=0.845>0.05).5.Bacterial culture of wound secretionsBacterial cultures were obtained from the wound secretions of patients in both groups at the time of admission,before stage Ⅱ surgery and on day 7 after stage Ⅱ surgery.On the day of admission:16 patients in the control group had positive bacterial cultures and 17 patients in the A-PRF group had positive bacterial cultures,with no statistical difference in the rate of positive bacterial cultures between the two groups(P=0.556>0.05).Pre-operative stage Ⅱsurgery:4 patients in the control group had positive bacterial culture and 6 patients in the APRF group had positive bacterial culture.There was no statistical difference in the rate of positive bacterial culture between the two groups(P=0.724>0.05),which was comparable.Day 7 after stage Ⅱ surgery:2 patients in the control group had positive bacterial cultures and 0 patients in the A-PRF group had positive bacterial cultures,with no statistical difference in the rate of positive bacterial cultures between the two groups(P=0.245>0.05).6.Hospitalization costsComparing the hospitalization cost of the two groups,the hospitalization cost of the APRF group(42755.84±3641.21 RMB)was lower than that of the control group(47705.40±3417.88 RMB),and there was a statistical difference in the hospitalization cost between the two groups(P=0.000<0.05).7.Occurrence of adverse eventsThe patients in both groups were followed up from 3 to 6 months(from the time of complete wound healing).In the control group,3 patients were lost to follow-up,2 patients had redness and pain in the original wound again,which improved after conservative treatment such as anti-infection and dressing change,and 2 patients had new breaks and infections in the affected foot,which improved after inpatient surgical treatment.In the APRF group,2 patients were lost to follow-up,1 patient had redness,swelling and pain in the original wound,which improved after conservative treatment such as anti-infection and dressing change.The incidence of adverse events was 18.18%in the control group and 4.35%in the A-PRF group,with no statistical difference between the two groups(P=0.293>0.05).8.Advanced platelet-rich fibrin morphology and structureUnder scanning electron microscopy:A-PRF is a mildly aggregated fibrin matrix consisting of fine fibrin structures,a large loosely arranged meshwork,and a scattered distribution of normal or deformed leukocytes and platelets in the gap.Conclusion:This study showed that A-PRF accelerated the healing of diabetic foot toe amputation wounds without increasing the occurrence of adverse effects and had a certain degree of biosafety,while reducing postoperative pain and the burden of hospitalization for patients.This provides a new approach to the treatment of toe amputations in today’s diabetic foot. |
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