The Study Of Macrophage Polarization In The Treatment Of Diabetic Foot Wounds With Osteomyelitis By Tibial Transverse Transport

Objective To explore the macrophage polarization in the treatment of diabetic foot wounds with osteomyelitis by tibial transverse transport.Method1.Observe the clinical characteristics of wound healing and the stages of wound healing process:(1)Inflammation period(before surgery): the time after tibial transverse transport to the clinical observation of no obvious necrotic tissue,congestion,edema and inflammatory secretions in the wound.It is the inflammation period;(2)Proliferation period(1 month after surgery): the time when the granulation tissue is observed to grow granularly until the wound edge epithelial cells crawl to the wound center to completely cover the wound;(3)Remodeling period: the epithelial cells on the edge of the wound completely cover the wound to the wound healing tissue,showing the texture,appearance and color of normal tissue.2.Take the wound marginal tissue in the inflammatory phase(preoperative)and proliferative phase(1 month after surgery),use CD86 monoclonal antibody to label M1 macrophages,CD163 monoclonal antibody to label M2 macrophages,and Ki-67 Monoclonal antibody marks the proliferation status of cells,use immunohistochemistry to detect CD86,CD163,Ki-67 positive cells,and use Image pro plus 6.0 software to calculate CD86,CD163 positive cells;then calculate the change of M1/M2 ratio;3.Take tissues at the wound edge during the inflammation period(before surgery)and proliferation period(1 month after surgery)to make tissue sections.Observe the wound tissue healing under microscope after HE staining.4.Diabetic foot angiography(CTA)was performed at the inflammatory stage(preoperative)and proliferative stage(1 month after surgery).Result1.Clinical staging characteristics of wound healing :(1)Inflammatory phase:Inflammatory cascade reaction occurred on the wound.Clinical observation showed necrotic tissue,congestion,edema and inflammatory secretions on the wound,and the wound was yellow and white.When these symptoms disappear,the wound enters the proliferative stage;(2)Proliferation phase: Clinical observation at this stage shows that fresh granulation tissue is formed on the wound surface,which grows in a granular shape,with a ruddy color,and Scraping surfaces is liable to bleed.The granulation tissue crawls from the edge of the wound to the center of the wound surface.With the proliferation of cells,the new skin tissue at the edge of the wound gradually crawled towards the center of the wound;(3)Remodeling stage:the epithelium completely covers the wound surface,and the appearance,color and texture of the regenerated tissue gradually approach to the normal tissue.2.Among the 12 randomly selected patients,M1 was 158.18 ±29.14 in the inflammatory phase(before surgery)and 79.74±13.96 in the proliferative phase(1month after surgery),P=0.000 < 0.05,showing a statistically significant difference.M2 in the inflammatory phase(before surgery)was 43.64±7.70,and M2 in the proliferative phase(1 month after surgery)was 32.27±6.62,P=0.001 < 0.05,showing a statistically significant difference.3.Among the 12 randomized patients,M1/M2 in the inflammatory phase(before surgery)was 3.62± 0.18,and M1/M2 in the proliferative phase(1 month after surgery)was 2.50±0.29,P=0.000 < 0.05,showing a statistically significant difference.4.The expression of ki-67 positive cells increased in the proliferative phase(1month after surgery)compared with that in the inflammatory phase(before surgery),and the number of cells in the proliferative state of the wound increased;5.After HE staining,the wound edge tissues were observed under the microscope: in the inflammatory stage(before surgery),the wound edge tissues were fragmentary,fractured,and the continuity of the tissue structure was poor.At the proliferation period(1 month after the operation),the skin structure was relatively complete,with good continuity of tissue structure and collagen deposition.6 Diabetic foot angiography(CTA)in the inflammatory phase(before surgery)and proliferative phase(1 month after surgery): the number of microvessels in the inflammatory phase was low;At the proliferative period,the number of microvessels increased and there was collateral circulation microangiogenesis.Conclusion1.One month after surgery,M1 and M2 type macrophages in the wound edge tissues were all lower than those before surgery.The reduction of macrophages indicated that the wound changed from high inflammatory state to low inflammatory state,M1/M2 decreased,ki-67 positive cell expression increased,and the number of proliferative cells in the wound increased,suggesting that tibial transverse transport could promote the wound from inflammation to proliferation.2.In the proliferation stage,M2 type macrophages promote the formation of neovascularization,granulation tissue formation and epithelial tissue regeneration of the wound,so as to promote surface repair;3.Tibial transverse transport can promote M1/M2 polarization and transform from M1 to M2,and the biological effect of M2 type macrophages can promote the regeneration and repair of wound tissue.