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Analysis of Therapeutic Effect of Skin Regenerative Therapy in Treating Diabetic Foot Ulcers
Add Time£º2011/8/11 16:16:08
Li shibin, zhang zuqi, huang zhengui, li wubin, xu miaoqing.
Burn and Trauma Center of Liugang Hospital, Liuzhou City, Guangxi Province.545002.
[Abstract]Objective: Analysis, summary and explore the feasibility and efficiency of skin regeneration medical technology to treat diabetic foot ulcer patients. Method: 32 diabetic foot ulcer inpatients received skin regeneration medical technology primarily and pro re nata combine with dermatoplasty to treat local wound healing. Result: Restoration of skin regeneration medical technology was 9/32(28.1%) patients, skin regeneration medical technology + skin transplantation was 12/32(37.5%) patients, skin regeneration medical technology + skin flap restoration was 5/32 (15.6%) patients, amputation was 6/32 (18.8%) patients. Conclusion: In time visiting doctor and treatment primarily with skin regeneration medical technology can effectively restore ulcer wound surface and decrease amputation rate of diabetic foot.
[Key words]: MEBT/MEBO; diabetic foot ulcer; insulin; therapy
Foot ulcer and gangrene is one of the most serious complications of diabetes, previously amputation was mostly used to treat [1], which brought great distress and lifetime disability to patients. From January 2001, our department registered 32 diabetic foot ulcer patients, on the basis of blood glucose control, we primarily used skin regeneration medical technology, pro re nata combined with dermatoplasty and skin flap restoration therapy, and obtained notable effectiveness in terms of promoting wound healing, relieving injury, distressomg and disability rate. Reports as follows:
1. General data
32 diabetic foot ulcer patients in our department for 5 years recently, all belong to diabetes type ¢ò, there was 26 males and 9 females. Age range was 38-79 years, mean age was 53.14¡À12.23 years. Duration of diabetes was 2-15 years, duration of diabetic foot was 28 days to 2 years, mean duration was 3.28¡À4.57 months. According to Wagner classification criterion,3 patients was 1 grade, 9 patients was 2 grade, 7 patients was 3 grade, 9 patients was 4 grade and 4 patients was 5 grade. minimum area of ulcer was 0.9¡Á0.5 cm and maximum area of ulcer was 10¡Á9.5cm, 21 patients have local flare, pain and haphalgesia, purulent secretions, crackles and deep sinus, bone tissue was corroded can be seen on X ray film, in other words concurrent infection£¬and infection rate was 65.6%.
2. Therapeutic method and results
1) General treatment: On the basis of blood glucose detection, regular insulin was routinely used in order to control blood glucose within 5.8-12.7mmol/L (fasting blood glucose), urine glucose(-~+), urine without ketobody; To patients with notable infection symptoms, bacteriology culture and drug sensitivity test was done to their blood and local secretions. On the basis of bacteriological diagnosis, we selected effective antibiotics to carry out anti-infective therapy; enhanced nutritional support therapy and paid attention to rectification anemia and so on.
2) Local treatment: To patients with more necrotic tissue previously, 1% iodophors was used to sterilize skin around wound, 3% hydrogen peroxide and stroke-physiological saline solution was used respectively to wash wound surface, then proceeded non-invasive debridement in order to get rid of necrotic tissue, osteonecrosis and aging white false membrane in the sinus and so on; subsequently, 3% hydrogen peroxide + stroke-physiological saline solution 250 ml + regular insulin 40-80U were used respectively to wash wound surface; finally, fresh 20-40g MEBO + regular insulin 8U gauze covered wound surface, pro re nate placed MEBO + regular insulin yam in the sinus, changed dressings 2-3 times/day, each time must thoroughly get rid of liquefaction and keep wound surface moist during therapy until healing. Paid attention to continue medication during therapy, didn¡¯t change to other drugs, dry and astringe type drugs were prohibited in order to keep wound surface moist and non-soak; during changing dressings, the principle was patients without pain, bleeding and without injury to normal tissue; during wound surface healing phase, protected ¡°fiber isolation membranes¡± on the wound surface, ensured physiogenic regeneration restoration of wound surface. To patients with larger wound surface, slower wound healing and surgery demanded, in condition of infection control, necrotic tissue clearance and granulation tissue was fine, wound surface still non-restoration for 45 days, we selected surgery therapy to close wound surface.
3) Results: Restoration of skin regeneration medical technology was 9/32(28.1%) patients, skin was smooth and soft without scar and dysfunction after healing, but wound surface was darkorchid and skin sensation was clumsy; skin regeneration medical technology + skin transplantation was 12/32(37.5%) patients, skin regeneration medical technology + skin flap restoration was 5/32(15.6%) patients, amputation was 6/32(18.8%) patients. Mean hospital stay was 25.51¡À13.72 days.
3. Discussions
With the improvement of living standard and changes of life style, diabetes(DM) prevalence rate was increased gradually in our country, moderate and advanced phase of diabetes cause diverse acute and chronic complications, foot ulcer and gangrene was one of the most serious complications. It is a kind of chronic and progressive vascular lesion, its primary cause is acra ischemia, neuropathy, infection and many kinds of causative factors. Diabetic foot ulcer can be  seen mostly among old people and disability rate is high. According to statistics, 50% amputation was carried out on diabetes inpatients in US [2],domestic reports: amputation rate of diabetic foot ulcer was 38.1%-75.0%[3], however, 32 patients received skin regeneration medical technology therapy in our study, at the same time, effectively restore wound surface, reduced amputation rate to 18.8%. Concurrent infection is the main cause of visiting doctors, 21(65.5%) patients with notable concurrent infection in our study, usually complicating serious infection or osteomyelitis due to delay of treatment, thus increased amputation rate. We should hold discretion attitude to carry out amputation in diabetic foot ulcer patients, only if foot ulcer was large and deep, serious infection or combined with osteomyelitis, or the lower limbs paresthesia or disappear, high amputation should be carried out as early as possible; We should generally consider utilize skin regeneration medical technology to deal with wound surface, control blood glucose, and repair ulcer wound surface after granulation grew well, accordingly decrease disability rate and increase life quality of patients.
Through therapy of 32 diabetic foot ulcer patients, we comprehended the mechanism of skin regeneration medical technology reducing high amputation rate was shown as following:
1) Analgesic effect: Due to ulcerative corrosion, pain nerve terminal of diabetic foot patients are bare, in addition to metabolites and microbiology invasion and stimulation to pain nerve terminal, thereby evoke pain[4],however, MEBO can isolate wound surface, avoid expose, dry and air direct stimulus to wound surface, and has automatic draining effect, especially posses activating blood circulation to dissipate blood stasis, detumescence and antipruritic drug components[5], these components can obviously improve local blood circulation to reach detumescence and analgesic purpose.
2) Prevention and cure infection effect: Wound surface nutrition of diabetic foot patients is poor and is good for bacteria growth, so infection opportunity is high. However, MEBO is a kind of framework ointments, it can cover wound surface by frame structure, and achieve wound surface changes from pathological condition to physiogenic condition [8], fundamentally improve repair condition of wound surface. In addition to protect wound surface, MEBO moist burn ointments also can inhibit proliferation rate of bacteria, induce microbial dissociation, decrease quantity of bacteria and produce of endotoxin. Empirical study demonstrate that MEBO posses broad spectrum antibiotic effect to G+ oxybiontic bacteria, G- bacteria, G+ endospore anaerobic bacteria, G- non-endospore anaerobic bacteria and fungus.
3) Enhance wound surface healing effect: Add appropriate amount of regular insulin to MEBO can obviously decrease blood glucose in local tissue. MEBO through biochemistry reaction such as hydrolyse, enzymolysis, rancidify, saponification, lipoid, esterification and so on, necrotic tissue  on the wound surface was expelled from superficies to interior through the way of liquification necrosis, at the same time, high glucose secretions was removed during local change dressings and in favor of ulcer healing. MEBO provides abundant nutritive substance including protein, fatty acids and sugars to diabetes patients[6], MEBO moist burn ointments contains abundant of nutritive substance necessary to wound surface healing, it can effectively offer regeneration nutrients necessary to ulcer wound surface healing and enhance regeneration repair, then accelerate wound surface healing procedure. MEBO also can enhance naturally isolation between necrosis bone tissue and normal bone tissue, effectively develop proliferation ability of wound surface epithelial cells and enhance wound surface healing [8].
In short, diabetes patients generally suffer from vigorous catabolism, poor microcirculation perfusion, dysfunctional firoblast miopragia, and declined growth of granulation. Meanwhile, conventional surgery risk is high and survival rate of skin after grafting is low. MEBO can improve histanoxia, contract blood vessels, decrease permeability of capillaries, enhance venous return and decrease exudation of wound surface; inhibit proliferation of majority of bacteria and relieve infection of wound surface; also enhance growth of granulation tissue and regeneration of capillaries. After treatment, in our study majority of patients¡¯ secretions were obviously reduced, fundus were fresh, islands grew well and wound surface can naturally healing, it avoid previously wound surface not healing for long time caused by repeatedly change dressings, deepen progressively or dry necrosis, dermoplasty for many times cannot survive, so have to carry out amputation. Authors think that we should reinforce hazard education on diabetes, in time visiting doctors and treatment with skin regeneration medical technology thereby, thus increase recovery rate of diabetic foot, decrease amputation rate, reduce recurrence rate and improve life quality of patients.
[1] Chi Zhisheng. ¡°Diabetology¡±, People's Health Publisher, Beijing, 1982: 328.
[2] Leonard A, Levy E. ¡°Pidemiology and Prevention of Diabetic Foot Disease¡±, In: Roberi G, Frykbe re (eds). ¡°The High Risk Foot in Diabetic Mellitus¡±, New York: Churchill, 1991:23.
[3] Kuang Ankun. ¡°Diabetes in China [M]¡±, Hunan Science and Technology Press, Hunan, 1989, 312
[4] Chen Dayong, Chief Editor, ¡°Dermatology¡± Second version, People's Health Publisher, 1989, 5
[5] Xu Rongxiang, ¡°General Medical Science for Burns, Wounds and Ulcers I [J]¡±, the Chinese Journal of Burns, Wounds& Surface Ulcers, 1989, (1):22.
[6] Xu Rongxiang, ¡°Entirely Improve the Burns Treatment Level with Medical Philosophy as Guidance [J]¡±, the Chinese Journal of Burns, Wounds& Surface Ulcers, 1998, (4):2~8.
[7] Qu Yunying, Xie Changhua, Ju Shengzhi, eds, ¡°Experimental Studies on MEBO¡¯s Antibacterial Effect [J]¡±, the Chinese Journal of Burns, Wounds& Surface Ulcers, 1998, 4: 15.
[8] Zhang Zhihua, eds. ¡°Treatment of Bone Exposure Wounds with MEBO [C]¡±, Academic Paper Collections of the Fifth National Burns, Wounds & Ulcers, 1998, 109.
Brief Introduction of the authors:
Li Shibing (1967~), Male, Quanzhou in Guangxi, graduated from Department of Medicine in Guangxi Medical University, Director of Department.
Zhang Zuqi (1977~), Male, Rong¡¯an in Guangxi, graduated from Department of Medicine in Guangxi Medical University, Chief Physician.
Huang Zhengui (1965~), Male, Liuzhou in Guangxi, graduated from Liuzhou Medical School in Guangxi, Chief Physician.

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