Abstract:

Objective　To explore the therapeutic effects of free anterolateral thigh perforator flap and free descending branch tissue flap of lateral circumflex femoral artery transplantation combined with vacuum sealing drainage in the treatment of diabetic foot. Methods　A total of 94 diabetic foot patients treated at the Second Affiliated Hospital of Air Force Medical University from January 2018 to March 2023 were prospectively selected as the research subjects. They were divided into two groups, group A and B, using the random number table method. In group A, 47 patients received free anterolateral thigh perforator flap transplantation, including 24 males and 23 females, aged (53.26±11.52) years, the wounds ranged from 4.2 cm × 5.4 cm to 8.3 cm × 10.2 cm, and the lesions were distributed at dorsum of foot in 15 cases, ankle in 18 cases, and heel in 14 cases. In group B, 47 patients received free descending branch tissue flap of lateral circumflex femoral artery transplantation, including 26 males and 21 females, aged (51.34±10.89) years, the wounds ranged from 3.5 cm × 4.5 cm to 7.5 cm × 9.5 cm, and the lesions were distributed at dorsum of foot in 17 cases, ankle in 16 cases, and heel in 14 cases. Both groups underwent debridement with vacuum sealing drainage before surgery. The efficacy, wound healing, growth cytokines in the wound area [vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and transforming growth factor-β1 (TGF-β1)], flap sensory function, and walking ability (evaluated by Holden's Functional Ambulation Classification Scale) were compared between the two groups. t test χ² test, and rank sum test were used. Results　Six months after treatment, the total effective rate of group A was higher than that of group B [97.87% (46/47) vs. 87.23% (41/47)], with a statistically significant difference (χ²=3.859, P=0.049). The wound healing time [(28.98±4.49) d], hospital stay [(18.98±5.36) d], and granulation tissue formation time [(21.58±4.22) d] in group A were shorter than those in group B [(31.38±4.76) d, (22.38±6.42) d, and (23.65±4.59) d], with statistically significant differences (all P<0.05). The levels of VEGF [(113.13±12.82) ng/L], bFGF [(70.08±6.87) ng/L], and TGF-β1 [(9.08±0.91) µg/L] in group A 1 month after surgery were higher than those in group B [(102.35±13.11) ng/L, (65.33±6.37) ng/L, and (8.09±0.83) µg/L], with statistically significant differences (all P<0.05). There was no statistically significant difference in the good appearance rate of flaps between the two groups (χ²=0.712, P=0.399). The normal rate of flap sensory function in group A was higher than that in group B [61.7% (29/47) vs. 40.42% (19/47)], with a statistically significant difference (χ²=4.257, P=0.039). The Holden's Functional Ambulation Classification in group A was better than that in group B, with a statistically significant difference (Z=10.513, P=0.033). Conclusion　The use of free anterolateral thigh perforator flap for the treatment of diabetic foot is superior to free descending branch tissue flap of lateral circumflex femoral artery, with faster wound healing and better recovery of foot and ankle function.

Key words:

Diabetic foot, Anterolateral thigh perforator flap, Descending branch of lateral circumflex femoral artery, Tissue flap, Transplantation,  , Vacuum sealing drainage

摘要：

目的　探讨游离股前外侧穿支皮瓣与游离旋股外侧动脉降支组织瓣移植分别联合封闭负压引流技术对糖尿病足的治疗效果。方法　前瞻性选取2018年1月至2023年3月于空军军医大学第二附属医院接受治疗的94例糖尿病足患者为研究对象，按随机数字表法分为A、B组。A组47例接受游离股前外侧穿支皮瓣移植，其中男24例、女23例，年龄（53.26±11.52）岁，创面范围4.2 cm×5.4 cm～8.3 cm×10.2 cm，病变部位分布为足背15例、足踝18例、足跟14例；B组47例接受游离旋股外侧动脉降支组织瓣移植，其中男26例、女21例，年龄（51.34±10.89）岁，创面范围3.5 cm×4.5 cm～7.5 cm×9.5 cm，病变部位分布为足背17例、足踝16例、足跟14例；两组术前均行封闭负压引流清创。比较两组患者疗效、创面愈合情况、创面生长细胞因子［血管内皮生长因子（VEGF）、碱性成纤维生长因子（bFGF）、转化生长因子-β1（TGF-β1）］、皮瓣感觉功能、行走能力［采用Holden步行功能分级量表评估］。采用t检验、χ²检验、秩和检验。结果　治疗后6个月，A组治疗总有效率高于B组［97.87%（46/47）比87.23%（41/47）］，差异有统计学意义（χ²=3.859，P=0.049）；A组创面愈合时间（28.98±4.49）d、住院时间（18.98±5.36）d、肉芽组织形成时间（21.58±4.22）d，均短于B组的（31.38±4.76）d、（22.38±6.42）d、（23.65±4.59）d，差异均有统计学意义（均P<0.05）；A组术后1个月创面VEGF（113.13±12.82）ng/L、bFGF（70.08±6.87）ng/L、TGF-β1（9.08±0.91）µg/L，均高于B组的（102.35±13.11）ng/L、（65.33±6.37）ng/L、（8.09±0.83）µg/L，差异均有统计学意义（均P<0.05）；两组皮瓣外观总优良率比较差异无统计学意义（χ²=0.712，P=0.399），A组皮瓣感觉功能正常率高于B组［61.7%（29/47）比40.42%（19/47）］，差异有统计学意义（χ²=4.257，P=0.039）；A组Holden步行功能分级情况优于B组，差异有统计学意义（Z=10.513，P=0.033）。结论　应用游离股前外侧穿支皮瓣移植治疗糖尿病足的疗效优于游离旋股外侧动脉降支组织瓣移植，创面愈合速度快，较大程度地恢复了患者的肢体功能。

关键词:

糖尿病足, 股前外侧穿支皮瓣, 旋股外侧动脉降支, 组织瓣, 移植, 封闭负压引流