| Objective:To evaluate the efficacy of autologous adipose extracellular matrix/stromal vascular fraction combined with skin stretder in the treatment of diabetes-related refractory wounds through clinical efficacy observation and basic experiments.To compare the effects of autologous adipose extracellular matrix/stromal vascular fraction combined with skin stretder,autologous adipose stem cell gel alone,alginate wet dressing dressing change in the treatment of diabetes-related refractory wounds.To explore the mechanism of autologous adipose extracellular matrix/stromal vascular fraction combined with skin stretderaffecting the healing of diabetes-related refractory wounds,so as to provide a richer theoretical basis and treatment methods for the clinical treatment of diabetes-related refractory wounds.Methods:Forty-five patients who met the standard and signed relevant documents in the affiliated Hospital of North Sichuan Medical College were randomly divided into three groups with 15 patients in each group.Group A was treated with autologous adipose extracellular matrix/tromal vascular fraction combined with skin stretder,group B was treated with autologous adipose extracellular matrix/stromal vascular fraction,and group C was treated with alginate wet dressing.The clinical data of the patients were collected,and the soft tissues of the wounds were scored by Lent-Soma.The wound pictures were collected 7 and 14 days after treatment to calculate the wound healing rate.The expressions of vascular endothelial growth factor(VEGF)and interleukin-6(IL-6)were semi-quantitatively detected by HEstaining,Masson staining and immunohistochemical staining,and the data were analyzed by SPSS22.0 statistical software.It is considered that P<0.05 is statistically significant.Results:1.There was no statistical significance in gender,visiting age and wound area at admission among the three groups(P>0.05),indicating comparability;2.After treatment,the three groups of patients were in good general condition,no obvious complications were observed at the treatment site,and no obvious adverse reactions occurred during treatment.Three groups after treatment of wounds were healing tendencies,collected before and after treatment in patients with 7 days,14 days pictures and calculate the healing of the wound,treatment after 7 days of A and B group(50.277±3.42%,46.807±2.44%)than group C(21.877±1.66%)had A higher rate of wound healing,and wound healing rate in group A than group B has also improved,comparing differences between groups was statistically significant(P<0.05),After 14 days of treatment,the wound healing rate of group A,B and C(58.87±3.35%,52.93±2.31%,29.00±1.44%)was further improved,and the difference between the three groups was statistically significant(P<0.05).3.According to Lent-Soma skin and soft tissue injury scoring criteria,the wound surface of patients was scored.After 7 days of treatment,groups A and B(1.20±0.11,1.80±0.11)were lower than group C(2.00±0.14);after 14 days,groups A and B(0.60±0.13,0.80±0.17)were lower than group C(1.33±0.12),with statistical significance(P<0.05),but there was no significant difference between groups A and B(P>0.05).4.HE staining was performed on the wound tissue to analyze the proliferation of fibroblasts on the wound surface.After 7 and 14 days of treatment,more fibroblasts were formed in groups A and B than in group C,and the difference was statistically significant(P<0.05).After 14 days of treatment,more fibroblasts were formed in group A than in group B,and more fibroblasts were formed in groups A and B than in group C,with statistical significance(P<0.05).5.Masson staining images of wound tissue were collected,and the collagen content of the three groups was analyzed by ImageJ.image analysis software.After 7 days of treatment,more collagen was produced in groups A and B(23.92±0.51,21.59±0.29)than in group C(19.96±0.26),with statistical significance(P<0.05),but there was no significant difference between group A and group B.After 14 days of treatment,collagen production in group A(34.52±1.21)was significantly higher than that in groups B and C(30.9±0.84,27.99±0.95),and collagen production in group A was also significantly higher than that in group B,with statistical significance(P<0.05).6.Wound tissue was collected for VEGF and IL-6 immunohistochemical staining:After 7 days of treatment,VEGF expression in group A and B(0.0645±0.0014,0.0604±0.0011)was more than that in group C(0.0554±0.0010),the difference was statistically significant(P<0.05).After 14 days of treatment,VEGF expression in group A(0.1471±0.0023)was significantly higher than that in group B and C(0.0954±0.0020,0.0794±0.0022),and there was also significant difference between group B and group C(P<0.05).7 days after the treatment of A and B group(0.00247±0.0010,0.00287±0.0016)compared with group C(0.0033±0.0011)wound tissue IL-6 expression decreased,in group A than group B wound tissue IL-6 expression is reduced,the difference was statistically significant(P<0.05),14 days after treatment group A and B(0.00177±0.0010,0.00197±0.0008)compared with group C(0.00247±0.0009)wound tissues significantly reduce the amount of IL-6 expression,group A compared with group B is also significantly lower more.The difference was statistically significant(P<0.05).Conclusion:1.Autologous adipose extracellular matrix/stromal vascular fraction has a definite effect in the treatment of diabetes-related refractory wounds.Combined with skin stretder,autologous adipose extracellular matrix/stromal vascular fraction has a better effect in improving the soft tissue condition of diabetes-related refractory wounds,promoting wound growth,improving wound inflammation,improving wound healing rate and promoting diabetes-related refractory wound healing.2.Autologous adipose extracellular matrix/stromal vascular fraction combined with skin stretder has a significant effect on the treatment of diabetes-related refractory wounds without obvious adverse reactions,which is a safe and reliable treatment method. |
