Effect Of Vacuum Sealing Drainage On Severe Diabetic Foot Ulcer With Ischemia After Interventional Therapy

Objective:Diabetic foot ulcers(DFUs)is a severe complication of the diabetes mellitus,which is the leading cause of non-traumatic lower limbs amputations.Its pathogenesis is multifactorial and multidisciplinary consultation is required.This study aims to explore the therapeutic effect of vacuum sealing drainage(VSD)on DFU patients who were treated with percutaneous transluminal angioplasty(PTA),and to analyze the related factors of poor prognosis.Methods:The ischemic DFU patients who received PTA in Tong Ren Hospital Shanghai Jiao Tong University School of Medicine from January 2017 to December 2018 were analyzed retrospectively.The patients were divided into mild group(Wagner 2)and severe group(Wagner 3～4)according to the Wagner grade.The severe group was further divided into VSD group and debridement group based on the debridement methods used.The demographic and clinical data of patients were obtained and analyzed.The change in ankle brachial index(ABI)between preoperative and postoperative day 180 was assessed in each group,and the total effective rate at 12 weeks after operation,as well as the number of dressing changes,antibiotic use time,healing time,hospitalization time,pain score and S(AD)SAD system score were compared.The number of adverse prognostic events(death or lower-limb amputation)during the follow-up of patients in each group was calculated,and the Kaplan Meier curve was generated to compare the event free survival rate between groups.Univariate and multivariate Cox regression models were used to determine the risk factors of adverse events in severe group.Results A total of 108 patients with DFU were included in this study,including 33 cases in the mild group and 75 cases in the severe group.In the severe group,47(62.7%)were treated with VSD and 28(33.3%)were treated with conventional debridement.The use rate of VSD in severe group was significantly higher than that in mild group(P<0.05).The lower limb ischemia of patients in VSD group and debridement group was significantly improved after PTA,but there was no significant difference in ABI between the two groups at different time points(P>0.05).The clinical efficacy results at 12 weeks after treatment showed that the proportions of markedly effective,effective and total effective rates in the VSD group were significantly higher than those in the debridement group(P<0.05),while there was no statistical difference compared with the mild group(P>0.05).Further analysis showed that the number of dressing changes,antibiotic use time,hospitalization time,healing time and visual analogue scale(VAS)in the VSD group were significantly lower than those in the debridement group(P<0.05).The Kaplan-Meier curve showed that the 3-year event-free survival rate in the VSD group was higher than that in the debridement group(P<0.05),while there was no statistical difference compared with the mild group(P>0.05).Cox regression showed that older age(RR=1.121),cerebrovascular disease(RR=9.903),lower preoperative ABI(RR=0.583),and use of debridement(RR=0.196)were the risk factors of adverse events in patients with severe ischemic DFU.Conclusion:VSD treatment can promote the healing of foot wounds after revascularization in patients with ischemic DFU,reduce the occurrence of amputation and death,and has satisfactory short-term and long-term clinical results.