EFFECTS OF INTERMITTENT IRRIGATION OF INSULIN SOLUTION COMBINED WITH CONTINUOUS DRAINAGE OF VACUUM SEALING DRAINAGE IN CHRONIC DIABETIC LOWER LIMB ULCERS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUNYong ¹ , FANWei ² ,  YANGWeixi ¹ , WANGGuangjun ¹ , YUGuojun ¹ , ZHANGDawei ¹ , WANGYibing ¹

1. Department of Burn and Plastic Surgery Huai'an First People's Hospital, Nanjing Medical University, Huai'an Jiangsu, 223300, P. R. China;
2. Department of Anesthesiology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an Jiangsu, 223300, P. R. China;

Corresponding author：

YANGWeixi, Email: sy217fw@163.com

Keywords：

Insulin; Vacuum sealing drainage; Irrigation therapy; Chronic diabetic lower limb ulcer

DOI：

10.7507/1002-1892.20150176

Video：

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Objective To investigate the effects of intermittent irrigation of insulin solution combined with continuous drainage of vacuum sealing drainage (VSD) in chronic diabetic lower limb ulcers. Methods Between January 2012 and December 2014, 45 patients with diabetic lower limb ulcer were treated with VSD (group A, n=15), with VSD combining irrigation of normal saline (group B, n=15), and with VSD combining irrigation of insulin solution (group C, n=15) after debridement. There was no significant difference in gender, age, course of ulcers, area and depth of wound, glycosylated hemoglobin, and Wagner grade among 3 groups (P>0.05), and the data were comparable. The levels of fasting blood glucose, 2-hour postprandial blood glucose, and random blood glucose were determined everyday during treatment. The contents of insulin growth factor 1 (IGF-1), tumor growth factor α (TNF-α), and nitric oxide (NO) in necrotic tissue after drainage were determined. The coverage rate and thickness of granulation tissue and clearance rate of bacteria in wound were calculated, the granulation tissue in the center of the wound was harvested for pathological observation with HE staining after 6 days of treatment. The second stage operation was performed according to the condition of wounds, and the time to the second stage operation and the method of the second stage operation were recorded and the survival rate of grafted skin or flap was calculated. Results The pathological staining showed that there were a few new microvessels and fibroblasts in group A after treatment;more new microvessels and fibroblasts were observed in group B;and many new microvessels and fibroblasts were found in group C. There was no significant difference in levels of fasting blood glucose, 2-hour postprandial blood glucose, and random blood glucose among 3 groups during treatment (P>0.05). The coverage rate and thickness of granulation tissue and clearance rate of bacteria in group C were significantly higher than those in groups A and B after treatment (P<0.05). The contents of IGF-1 and NO were significantly increased and TNF-α was significantly decreased in group C when compared with those in group A (P<0.05). Compared with group B, IGF-1 and NO contents were significantly increased at 3-6 days and at 2-6 days respectively, and TNF-α content was significantly decreased at 3-6 days in group C (P<0.05). The method of the second stage operation showed no significant difference among 3 groups (χ²=2.920, P=0.230), but the time to the second stage operation in group C was significantly shorter than that in groups A and B (P<0.05), and the survival rate of grafted skin or flap in group C was significantly higher than that in groups A and B (P<0.05). Conclusion The treatment of diabetic lower limb ulcers with intermittent irrigation of insulin solution combined with continuous drainage of VSD can reduce inflammatory reaction effectively, promote development of granulation tissue, improve recovery function of tissue, increase the rate and speed of wound healing obviously, but it has no effect on blood glucose levels.

Citation： SUNYong, FANWei, YANGWeixi, WANGGuangjun, YUGuojun, ZHANGDawei, WANGYibing. EFFECTS OF INTERMITTENT IRRIGATION OF INSULIN SOLUTION COMBINED WITH CONTINUOUS DRAINAGE OF VACUUM SEALING DRAINAGE IN CHRONIC DIABETIC LOWER LIMB ULCERS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(7): 812-817. doi: 10.7507/1002-1892.20150176 Copy

1.	于铁强,左玉明,王月光,等.封闭式负压引流技术联合腓肠神经营养血管皮瓣修复儿童足跟部软组织缺损.中国修复重建外科杂志,2013,27(5):637-638.
2.	Fleischmann W,Strecker W,Bombelli M,et al.Vacuum sealing as treatment of soft tissue damage in open fractures.Unfallchirurg,1993,96(9):488-492.
3.	Apelqvist J,Bakker K,van Houtum WH,et al.International consensus and practical guidelines on the management and the prevention of the diabetic foot.Diabetes Metab Res Rev,2000,16 Suppl 1:S84-92.
4.	Wagner FW Jr.The dysvascular foot:a system for diagnosis and treatment.Foot Ankle,1981,2(2):64-122.
5.	姚元章,黄显凯,麻晓林,等.创伤性软组织缺损的负压封闭治疗.中国修复重建外科杂志,2002,16(6):388-390.
6.	Scimeca CL,Bharara M,Fisher TK,et al.Novel use of insulin in continuous-instillation negative pressure wound therapy as "wound chemotherapy".J Diabetes Sci Technol,2010,4(4):820-824.
7.	李栋梁,李庆霞,彭代智.数码照相结合Photoshop软件测量平面创面面积.中华烧伤杂志,2010,26(1):48.
8.	孙剑伟,孙建辉,张春才.真空辅助闭合技术修复糖尿病足溃疡:随机分组、两阶段交叉设计的方差分析.中国组织工程研究与临床康复,2007,11(44):8908-8911.
9.	陈楚芬,谢肖霞,李爱利,等.负压创面疗法联合冲洗在糖尿病足溃疡治疗中的疗效研究.中华损伤与修复杂志(电子版),2012,7(6):70-72.
10.	Cortas NK,Wakid NW.Determination of inorganic nitrate in serum and urine by a kinetic cadmium-reduction method.Clin Chem,1990,36(8 Pt 1):1440-1443.
11.	11谭善彰,张继,王晖,等.不同蒂型静脉皮瓣成活率的实验研究.中华整形外科杂志,2006,22(3):196-199.
12.	Hemkens LG,Waltering A.Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers:a multicenter randomized controlled trial:response to Blume et al.Diabetes Care,2008,31(10):631-636.
13.	Argenta LC,Morykwas MJ.Vacuum-assisted closure:a new method for wound control and treatment:clinical experience.Ann Plast Surg,1997,38(6):563-576.
14.	张陈威,柳大烈,梁智,等.封闭式负压引流与人工真皮联合应用治疗下肢慢性溃疡.中国修复重建外科杂志,2013,27(8):1023-1024.
15.	Baharestani M,Amjad I,Bookout K,et al.V.A.C.Therapy in the management of paediatric wounds:clinical review and experience.Int Wound J,2009,6 Suppl 1:1-26.
16.	黄智勇,陈大夫,钟宇,等.自制简易封闭式负压引流装置修复四肢深度创面.中国修复重建外科杂志,2011,25(9):1149-1150.
17.	Chen DK,Frizzi KE,Guernsey LS,et al.Repeated monitoring of corneal nerves by confocal microscopy as an index of peripheral neuropathy in type-1 diabetic rodents and the effects of topical insulin.J Peripher Nerv Syst,2013,18(4):306-315.
18.	Chang X,Sun Y,Han S,et al.MiR-203 inhibits melanoma invasive and proliferative abilities by targeting the polycomb group gene BMI1.Biochem Biophys Res Commum,2015,456(1):361-366.
19.	Wilson JM,Baines R,Babu ED,et al.A role for topical insulin in the management problematic surgical wounds.Ann R Coll Surg Engl,2008,90(2):160.

1. 于铁强,左玉明,王月光,等.封闭式负压引流技术联合腓肠神经营养血管皮瓣修复儿童足跟部软组织缺损.中国修复重建外科杂志,2013,27(5):637-638.
2. Fleischmann W,Strecker W,Bombelli M,et al.Vacuum sealing as treatment of soft tissue damage in open fractures.Unfallchirurg,1993,96(9):488-492.
3. Apelqvist J,Bakker K,van Houtum WH,et al.International consensus and practical guidelines on the management and the prevention of the diabetic foot.Diabetes Metab Res Rev,2000,16 Suppl 1:S84-92.
4. Wagner FW Jr.The dysvascular foot:a system for diagnosis and treatment.Foot Ankle,1981,2(2):64-122.
5. 姚元章,黄显凯,麻晓林,等.创伤性软组织缺损的负压封闭治疗.中国修复重建外科杂志,2002,16(6):388-390.
6. Scimeca CL,Bharara M,Fisher TK,et al.Novel use of insulin in continuous-instillation negative pressure wound therapy as "wound chemotherapy".J Diabetes Sci Technol,2010,4(4):820-824.
7. 李栋梁,李庆霞,彭代智.数码照相结合Photoshop软件测量平面创面面积.中华烧伤杂志,2010,26(1):48.
8. 孙剑伟,孙建辉,张春才.真空辅助闭合技术修复糖尿病足溃疡:随机分组、两阶段交叉设计的方差分析.中国组织工程研究与临床康复,2007,11(44):8908-8911.
9. 陈楚芬,谢肖霞,李爱利,等.负压创面疗法联合冲洗在糖尿病足溃疡治疗中的疗效研究.中华损伤与修复杂志(电子版),2012,7(6):70-72.
10. Cortas NK,Wakid NW.Determination of inorganic nitrate in serum and urine by a kinetic cadmium-reduction method.Clin Chem,1990,36(8 Pt 1):1440-1443.
11. 11谭善彰,张继,王晖,等.不同蒂型静脉皮瓣成活率的实验研究.中华整形外科杂志,2006,22(3):196-199.
12. Hemkens LG,Waltering A.Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers:a multicenter randomized controlled trial:response to Blume et al.Diabetes Care,2008,31(10):631-636.
13. Argenta LC,Morykwas MJ.Vacuum-assisted closure:a new method for wound control and treatment:clinical experience.Ann Plast Surg,1997,38(6):563-576.
14. 张陈威,柳大烈,梁智,等.封闭式负压引流与人工真皮联合应用治疗下肢慢性溃疡.中国修复重建外科杂志,2013,27(8):1023-1024.
15. Baharestani M,Amjad I,Bookout K,et al.V.A.C.Therapy in the management of paediatric wounds:clinical review and experience.Int Wound J,2009,6 Suppl 1:1-26.
16. 黄智勇,陈大夫,钟宇,等.自制简易封闭式负压引流装置修复四肢深度创面.中国修复重建外科杂志,2011,25(9):1149-1150.
17. Chen DK,Frizzi KE,Guernsey LS,et al.Repeated monitoring of corneal nerves by confocal microscopy as an index of peripheral neuropathy in type-1 diabetic rodents and the effects of topical insulin.J Peripher Nerv Syst,2013,18(4):306-315.
18. Chang X,Sun Y,Han S,et al.MiR-203 inhibits melanoma invasive and proliferative abilities by targeting the polycomb group gene BMI1.Biochem Biophys Res Commum,2015,456(1):361-366.
19. Wilson JM,Baines R,Babu ED,et al.A role for topical insulin in the management problematic surgical wounds.Ann R Coll Surg Engl,2008,90(2):160.

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EFFECTS OF INTERMITTENT IRRIGATION OF INSULIN SOLUTION COMBINED WITH CONTINUOUS DRAINAGE OF VACUUM SEALING DRAINAGE IN CHRONIC DIABETIC LOWER LIMB ULCERS

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