Efficacy Of Endovascular Intervention Combined With Vacuum Sealing Drainage In The Treatment Of Diabetic Foot Wound

ObjectiveDiabetic foot related refractory wound is one of the most serious complications in the late stage of diabetes,which causes huge mental and economic burden to patients every year.At present,the treatment methods include conservative treatment such as medicine,debridement and dressing change,vacuum sealing drainage,and surgical treatment such as skin grafting and bypass.In recent years,there are interventional treatment of opening the inferior genicular artery of diabetic foot,but the effect of these methods is not satisfactory.To analyze the related data of 24 patients who received combined therapy(endovascular reconstruction of lower extremity arteries on the basis of conservative treatment with the best drugs,debridement and negative pressure suction),and preliminarily to explore the safety and effectiveness of combined therapy in the treatment of diabetic foot related refractory wounds,and provided a certain reference for clinical treatment of diabetic foot ulcer healing.MethodsThe clinical and follow-up data of 50 patients with diabetic foot ulcer wound treated in our department from January 2017 to August 2019 were collected and analyzed retrospectively.According to different treatment methods,they were divided into two groups: group A(best drugs treatment,debridement and negative pressure suction),n = 26,male 20,female 6,mean age 66.2 ± 5.15,group B(endovascular reconstruction of lower extremity arteries on the basis of conservative treatment),n =24,male 18,female 6,mean age 65.5 ± 4.62.All patients were followed up for 12 months.The ankle brachial index(ABI)at 1 month,3 months and 6 months,perioperative complications,wound healing rate,amputation rate,healing days,ulcer recurrence rate and walking distance after 12 months were evaluated after treatment.ResultsSurgical results: In the combined treatment group,the success rate of arterial reconstruction was 100%.There were 2 cases of puncture point pseudoaneurysm and4 cases of puncture point hematoma in perioperative complications,which were improved after re pressurization.5 cases of limb swelling after interventional operation were improved after symptomatic treatment.Follow-up results:12 months after discharge,the healing days of conservative treatment group and combined treatment group were 56.00 ± 19.00 and 32.00 ± 12.00 respectively(P < 0.001),the wound healing rates at 12 months were 65.38% and 79.17% respectively(P < 0.001),and the small / large amputation rates at 12 months were 30.77% and 16.67%respectively(P < 0.001).The ulcer recurrence rate of conservative treatment group was 30.77%,while that of combined treatment group was 0.The walking distance after 12 months is 310.00 ± 114.00 m and 523.00 ± 152.00 m respectively(P < 0.001).The ABI at 1 month was(0.66±0.11 and 0.77±0.12),at 3 month was(0.67±0.16 and 0.81±0.13),and at 6 month was(0.67±0.13 and 0.82±0.17).(P<0.001)ConclusionCompared with the conservative treatment,the combined treatment group has higher wound healing rate and quality of life,and the short and medium term follow-up results are satisfactory.