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.	于鐵強,左玉明,王月光,等.封閉式負壓引流技術聯合腓腸神經營養血管皮瓣修復兒童足跟部軟組織缺損.中國修復重建外科雜志,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,黃顯凱,麻曉林,等.創傷性軟組織缺損的負壓封閉治療.中國修復重建外科雜志,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.	李棟梁,李慶霞,彭代智.數碼照相結合Photoshop軟件測量平面創面面積.中華燒傷雜志,2010,26(1):48.
8.	孫劍偉,孫建輝,張春才.真空輔助閉合技術修復糖尿病足潰瘍:隨機分組、兩階段交叉設計的方差分析.中國組織工程研究與臨床康復,2007,11(44):8908-8911.
9.	陳楚芬,謝肖霞,李愛利,等.負壓創面療法聯合沖洗在糖尿病足潰瘍治療中的療效研究.中華損傷與修復雜志(電子版),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譚善彰,張繼,王暉,等.不同蒂型靜脈皮瓣成活率的實驗研究.中華整形外科雜志,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.	張陳威,柳大烈,梁智,等.封閉式負壓引流與人工真皮聯合應用治療下肢慢性潰瘍.中國修復重建外科雜志,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.	黃智勇,陳大夫,鐘宇,等.自制簡易封閉式負壓引流裝置修復四肢深度創面.中國修復重建外科雜志,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. 于鐵強,左玉明,王月光,等.封閉式負壓引流技術聯合腓腸神經營養血管皮瓣修復兒童足跟部軟組織缺損.中國修復重建外科雜志,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,黃顯凱,麻曉林,等.創傷性軟組織缺損的負壓封閉治療.中國修復重建外科雜志,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. 李棟梁,李慶霞,彭代智.數碼照相結合Photoshop軟件測量平面創面面積.中華燒傷雜志,2010,26(1):48.
8. 孫劍偉,孫建輝,張春才.真空輔助閉合技術修復糖尿病足潰瘍:隨機分組、兩階段交叉設計的方差分析.中國組織工程研究與臨床康復,2007,11(44):8908-8911.
9. 陳楚芬,謝肖霞,李愛利,等.負壓創面療法聯合沖洗在糖尿病足潰瘍治療中的療效研究.中華損傷與修復雜志(電子版),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譚善彰,張繼,王暉,等.不同蒂型靜脈皮瓣成活率的實驗研究.中華整形外科雜志,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. 張陳威,柳大烈,梁智,等.封閉式負壓引流與人工真皮聯合應用治療下肢慢性潰瘍.中國修復重建外科雜志,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. 黃智勇,陳大夫,鐘宇,等.自制簡易封閉式負壓引流裝置修復四肢深度創面.中國修復重建外科雜志,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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