Clinical study of ultrasonic debridement combined with autolytic debridement in the treatment of diabetic foot ulcers_West China Medical Journal

Authors：

CHANG Chunlei , QI Xiaoxia , CHEN Shihong ,  CAI Yunmin

Wound Diagnosis and Treatment Center, Jinshan Hospital of Fudan University, Shanghai 201508, P. R. China;

Corresponding author：

CAI Yunmin, Email: cymajj@126.com

Keywords：

Diabetic foot ulcers; Ultrasound debridement; Autolytic debridement; Curative effect

DOI：

10.7507/1002-0179.202102071

Video：

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Objective To explore the clinical efficacy of ultrasound debridement combined with autolytic debridement in the treatment of diabetic foot ulcers.Methods A total of 60 diabetic foot ulcers patients who were diagnosed and treated in Jinshan Hospital of Fudan University from April 2019 to April 2020 were enrolled in the study and randomly divided into two groups, with 30 cases in each group. The trial group received autolytic cleansing combined with ultrasound debridement treatment, and the control group only received autolytic debridement treatment. The baseline conditions, wound treatment efficacy, number of dressing changes, length of hospital stay, treatment cost, wound healing time, wound shrinkage rate, and the time required for the wound to turn into 100% red granulation were compared between the two groups.Results There was no statistically significant difference in gender, age, duration of diabetes or Wagner grade of diabetic foot between the two groups (P>0.05). The efficacy of wound healing in the trial group was better than that in the control group (Z=−2.146, P=0.032). The number of dressing changes [(11.76±2.23) vs. (17.34±4.43) times] and the length of stay [(18.03±3.73) vs. (25.43±4.43) d] in the trial group were lower than those in the control group, and the differences were statistically significant (P<0.05). The difference in treatment cost between the two groups was not statistically significant (P>0.05). The wound healing time of the trial group [(48.43±18.34) vs. (65.24±19.62) d], the wound shrinkage rate [(78.35±8.34)% vs. (56.53±6.54)%] and the time required for the wound to turn into 100% red granulation [(16.34±2.42) vs. (24.55±3.23) d] were better than those of the control group, and the differences were statistically significant (P<0.05). During the treatment process, no patient in the trial group had wound bleeding and had difficulty in stopping bleeding during ultrasonic debridement, and no patient had intolerable pain related to ultrasonic debridement. No patients in either group withdrew early.Conclusions Ultrasound debridement combined with autolytic debridement can effectively improve the curative effect of patients with diabetic foot ulcers and shorten the wound healing time. Therefore, it is worthy of promotion and application in the wound care of patients with diabetic foot ulcers.

Citation： CHANG Chunlei, QI Xiaoxia, CHEN Shihong, CAI Yunmin. Clinical study of ultrasonic debridement combined with autolytic debridement in the treatment of diabetic foot ulcers. West China Medical Journal, 2021, 36(4): 461-464. doi: 10.7507/1002-0179.202102071 Copy

1.	Lázaro-Martínez JL, Álvaro-Afonso FJ, García-Álvarez Y, et al. Ultrasound-assisted debridement of neuroischaemic diabetic foot ulcers, clinical and microbiological effects: a case series. J Wound Care, 2018, 27(5): 278-286.
2.	Michailidis L, Bergin SM, Haines TP, et al. Healing rates in diabetes-related foot ulcers using low frequency ultrasonic debridement versus non-surgical sharps debridement: a randomised controlled trial. BMC Res Notes, 2018, 11(1): 732.
3.	Campitiello F, Mancone M, Corte AD, et al. An evaluation of an ultrasonic debridement system in patients with diabetic foot ulcers: a case series. J Wound Care, 2018, 27(4): 222-228.
4.	Wang R, Feng Y, Di B. Comparisons of negative pressure wound therapy and ultrasonic debridement for diabetic foot ulcers: a network meta-analysis. Int J Clin Exp Med, 2015, 8(8): 12548-12556.
5.	马艳敏. 超声清创术联合封闭负压引流术在糖尿病足溃疡中的临床应用. 实用糖尿病杂志, 2020, 16(3): 109-110.
6.	Swanson T, Lázaro-Martínez JL, Braumann C, et al. Ultrasonic-assisted wound debridement: report from a closed panel meeting. J Wound Care, 2020, 29(2): 128-135.
7.	何梦龙, 叶琪毅, 邱志辉, 等. 超声清创刀结合美宝烧伤膏治疗糖尿病足溃疡创面的疗效观察. 云南医药, 2020, 41(4): 352-353, 359.
8.	Michailidis L, Bergin SM, Haines TP, et al. A systematic review to compare the effect of low-frequency ultrasonic versus nonsurgical sharp debridement on the healing rate of chronic diabetes-related foot ulcers. Ostomy Wound Manage, 2018, 64(9): 39-46.
9.	何灵杰, 崔含, 黄广英, 等. 封闭式负压引流联合超声清创术治疗糖尿病足的效果. 广东医学, 2018, 39(增刊1): 195-197.
10.	秦慧, 徐芬芳, 黄成龙, 等. 超声清创对肛瘘术后换药的效果观察. 中西医结合研究, 2017, 9(4): 198-199, 202.
11.	梁渝捷, 陈大伟, 文晓蓉, 等. 联合应用自体富血小板凝胶与 β 受体阻滞剂成功治愈缺血性糖尿病足溃疡 1 例报告. 四川大学学报(医学版), 2020, 51(4): 582-586.
12.	Kamineni S, Huang C. The antibacterial effect of sonication and its potential medical application. SICOT J, 2019, 5: 19.
13.	张嘉鹏, 陈佩仪, 赵子煜. 超声清创对糖尿病足治疗效果的 Meta 分析. 循证护理, 2018, 4(5): 389-393.
14.	中国医疗保健国际交流促进会糖尿病足病分会, 国际血管联盟中国分部糖尿病足病专家委员会. 中国糖尿病足诊治指南. 中国临床医生杂志, 2020, 48(1): 19-27.
15.	赵劲民, 李刚. 胫骨横向骨搬移技术治疗糖尿病足的专家共识(2020). 中国修复重建外科杂志, 2020, 34(8): 945-950.
16.	Nguyen TT, Ding D, Wolter WR, et al. Validation of matrix metalloproteinase-9 (MMP-9) as a novel target for treatment of diabetic foot ulcers in humans and discovery of a potent and selective small-molecule MMP-9 inhibitor that accelerates healing. J Med Chem, 2018, 61(19): 8825-8837.
17.	柯瑜君, 陈鹭, 林文谦, 等. 右美托咪定局部用药对糖尿病足患者罗哌卡因坐骨神经阻滞半数有效浓度的影响. 福建医科大学学报, 2020, 54(3): 192-195.
18.	何梦龙, 叶琪毅, 刘文革, 等. 超声清创联合湿润包扎在糖尿病足保肢治疗中效果研究. 中国现代药物应用, 2020, 14(7): 62-63.
19.	何梦龙, 叶琪毅, 刘文革, 等. 超声清创联合负压引流技术治疗糖尿病足溃疡临床分析. 岭南急诊医学杂志, 2020, 25(2): 181-183.
20.	Bajpai A, Nadkarni S, Neidrauer M, et al. Effects of non-thermal, non-cavitational ultrasound exposure on human diabetic ulcer healing and inflammatory gene expression in a pilot study. Ultrasound Med Biol, 2018, 44(9): 2043-2049.
21.	吴显惠. 超声清创在糖尿病足病换药中的应用. 名医, 2020(10): 214-215.
22.	Esposito S, De Simone G, Gioia R, et al. Deep tissue biopsy vs. superficial swab culture, including microbial loading determination, in the microbiological assessment of skin and soft tissue infections (SSTIs). J Chemother, 2017, 29(3): 154-158.
23.	Koreyba KA, Kudykin MN, Minabutdinov AR. Treatment of wound defects in patients with neuroischemic form of diabetic foot syndrome. Khirurgiia (Mosk), 2015(7): 69-74.
24.	楚伟英, 叶贞, 邓博, 等. 超声清创结合局部氧疗治疗糖尿病足 Wagner2 级创面的效果观察. 广东医科大学学报, 2020, 38(1): 67-69.
25.	林双, 袁丽, 杨小玲, 等. 超声水刀联合负压滴灌治疗在慢性难愈性糖尿病足中的应用效果. 四川医学, 2019, 40(7): 718-722.
26.	李丙蓉, 侯丽梅, 刘瑶丽, 等. 超声水刀清创系统联合封闭式负压引流冲洗在慢性糖尿病足创面治疗中的应用. 解放军医药杂志, 2020, 32(9): 30-33, 43.
27.	籍胤玺, 金毅, 金文波. 封闭式负压引流联合超声清创术治疗糖尿病足溃疡的疗效. 中国现代医学杂志, 2019, 29(1): 108-112.

1. Lázaro-Martínez JL, Álvaro-Afonso FJ, García-Álvarez Y, et al. Ultrasound-assisted debridement of neuroischaemic diabetic foot ulcers, clinical and microbiological effects: a case series. J Wound Care, 2018, 27(5): 278-286.
2. Michailidis L, Bergin SM, Haines TP, et al. Healing rates in diabetes-related foot ulcers using low frequency ultrasonic debridement versus non-surgical sharps debridement: a randomised controlled trial. BMC Res Notes, 2018, 11(1): 732.
3. Campitiello F, Mancone M, Corte AD, et al. An evaluation of an ultrasonic debridement system in patients with diabetic foot ulcers: a case series. J Wound Care, 2018, 27(4): 222-228.
4. Wang R, Feng Y, Di B. Comparisons of negative pressure wound therapy and ultrasonic debridement for diabetic foot ulcers: a network meta-analysis. Int J Clin Exp Med, 2015, 8(8): 12548-12556.
5. 马艳敏. 超声清创术联合封闭负压引流术在糖尿病足溃疡中的临床应用. 实用糖尿病杂志, 2020, 16(3): 109-110.
6. Swanson T, Lázaro-Martínez JL, Braumann C, et al. Ultrasonic-assisted wound debridement: report from a closed panel meeting. J Wound Care, 2020, 29(2): 128-135.
7. 何梦龙, 叶琪毅, 邱志辉, 等. 超声清创刀结合美宝烧伤膏治疗糖尿病足溃疡创面的疗效观察. 云南医药, 2020, 41(4): 352-353, 359.
8. Michailidis L, Bergin SM, Haines TP, et al. A systematic review to compare the effect of low-frequency ultrasonic versus nonsurgical sharp debridement on the healing rate of chronic diabetes-related foot ulcers. Ostomy Wound Manage, 2018, 64(9): 39-46.
9. 何灵杰, 崔含, 黄广英, 等. 封闭式负压引流联合超声清创术治疗糖尿病足的效果. 广东医学, 2018, 39(增刊1): 195-197.
10. 秦慧, 徐芬芳, 黄成龙, 等. 超声清创对肛瘘术后换药的效果观察. 中西医结合研究, 2017, 9(4): 198-199, 202.
11. 梁渝捷, 陈大伟, 文晓蓉, 等. 联合应用自体富血小板凝胶与 β 受体阻滞剂成功治愈缺血性糖尿病足溃疡 1 例报告. 四川大学学报(医学版), 2020, 51(4): 582-586.
12. Kamineni S, Huang C. The antibacterial effect of sonication and its potential medical application. SICOT J, 2019, 5: 19.
13. 张嘉鹏, 陈佩仪, 赵子煜. 超声清创对糖尿病足治疗效果的 Meta 分析. 循证护理, 2018, 4(5): 389-393.
14. 中国医疗保健国际交流促进会糖尿病足病分会, 国际血管联盟中国分部糖尿病足病专家委员会. 中国糖尿病足诊治指南. 中国临床医生杂志, 2020, 48(1): 19-27.
15. 赵劲民, 李刚. 胫骨横向骨搬移技术治疗糖尿病足的专家共识(2020). 中国修复重建外科杂志, 2020, 34(8): 945-950.
16. Nguyen TT, Ding D, Wolter WR, et al. Validation of matrix metalloproteinase-9 (MMP-9) as a novel target for treatment of diabetic foot ulcers in humans and discovery of a potent and selective small-molecule MMP-9 inhibitor that accelerates healing. J Med Chem, 2018, 61(19): 8825-8837.
17. 柯瑜君, 陈鹭, 林文谦, 等. 右美托咪定局部用药对糖尿病足患者罗哌卡因坐骨神经阻滞半数有效浓度的影响. 福建医科大学学报, 2020, 54(3): 192-195.
18. 何梦龙, 叶琪毅, 刘文革, 等. 超声清创联合湿润包扎在糖尿病足保肢治疗中效果研究. 中国现代药物应用, 2020, 14(7): 62-63.
19. 何梦龙, 叶琪毅, 刘文革, 等. 超声清创联合负压引流技术治疗糖尿病足溃疡临床分析. 岭南急诊医学杂志, 2020, 25(2): 181-183.
20. Bajpai A, Nadkarni S, Neidrauer M, et al. Effects of non-thermal, non-cavitational ultrasound exposure on human diabetic ulcer healing and inflammatory gene expression in a pilot study. Ultrasound Med Biol, 2018, 44(9): 2043-2049.
21. 吴显惠. 超声清创在糖尿病足病换药中的应用. 名医, 2020(10): 214-215.
22. Esposito S, De Simone G, Gioia R, et al. Deep tissue biopsy vs. superficial swab culture, including microbial loading determination, in the microbiological assessment of skin and soft tissue infections (SSTIs). J Chemother, 2017, 29(3): 154-158.
23. Koreyba KA, Kudykin MN, Minabutdinov AR. Treatment of wound defects in patients with neuroischemic form of diabetic foot syndrome. Khirurgiia (Mosk), 2015(7): 69-74.
24. 楚伟英, 叶贞, 邓博, 等. 超声清创结合局部氧疗治疗糖尿病足 Wagner2 级创面的效果观察. 广东医科大学学报, 2020, 38(1): 67-69.
25. 林双, 袁丽, 杨小玲, 等. 超声水刀联合负压滴灌治疗在慢性难愈性糖尿病足中的应用效果. 四川医学, 2019, 40(7): 718-722.
26. 李丙蓉, 侯丽梅, 刘瑶丽, 等. 超声水刀清创系统联合封闭式负压引流冲洗在慢性糖尿病足创面治疗中的应用. 解放军医药杂志, 2020, 32(9): 30-33, 43.
27. 籍胤玺, 金毅, 金文波. 封闭式负压引流联合超声清创术治疗糖尿病足溃疡的疗效. 中国现代医学杂志, 2019, 29(1): 108-112.

West China Medical Journal

Clinical study of ultrasonic debridement combined with autolytic debridement in the treatment of diabetic foot ulcers

Abstract Full text Figures/Tables Video References Cited by

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