[摘要]目的：PRP联合VSD对糖尿病足溃疡创面皮片移植患者创面愈合及bFGF、TGF-β水平的影响。方法：纳入笔者医院2020年2月-2024年1月收治的67例糖尿病足溃疡患者，按照随机数字表法将其分为VSD组（33例，行VSD联合皮片移植术）与PRP+VSD组（34例，行PRP＋VSD联合皮片移植术）。比较两组临床疗效、溃疡面积变化、肉芽组织形成时间、创面愈合时间、截肢率、细胞因子（bFGF、TGF-β）表达水平、并发症及瘢痕情况。结果：植皮前，PRP+VSD组总有效率为97.06%，高于VSD组的81.82%（P＜0.05）；PRP+VSD组VSD治疗后1、2、3周的溃疡面积均显著低于VSD组（P＜0.05）；PRP+VSD组肉芽组织形成时间、愈合时间及截肢率均低于VSD组（P＜0.05）；VSD治疗后第3周，两组患者细胞因子表达水平（bFGF、TGF-β）均上升（P＜0.05），且PRP+VSD组高于VSD组（P＜0.05）；两组并发症发生率比较差异不具有统计学意义（P＞0.05）；植皮术后第3周，PRP+VSD组VSS总分及各项评分均低于VSD组（P＜0.05）。结论：PRP联合负压封闭引流行皮片移植术可有效治疗糖尿病足溃疡，促进创面愈合，恢复肢体美观度，安全有效，值得应用。

[关键词]糖尿病足溃疡；自体富血小板血浆（PRP）；负压封闭引流（VSD）；皮片移植术

[中图分类号]R622" " [文献标志码]A" " [文章编号]1008-6455（2025）06-0039-04

Effect of PRP Combined with VSD on Wound Healing and bFGF and TGF-β Levels in Patients with Diabetic Foot Ulcer after Skin Grafting

ZHAO Jingfeng， TUO Xiaoye， LI Tao， OUYANG Simin， FENG Guang

（ Department of Plastic and Reconstructive Surgery， Peking University Shougang Hospital， Beijing 100144， China ）

Abstract： Objective" To explore the influence of autologous platelet-rich plasma （PRP） combined with vacuum sealing drainage （VSD） and skin grafting on wound healing and levels of basic fibroblast growth factor （bFGF） and transforming growth factor-β （TGF-β） in patients with diabetic foot ulcer. Methods" Sixty-seven patients with diabetic foot ulcers in the author's hospital from February 2020 to January 2024 were enrolled. According to the random number table method， they were divided into VSD group （33 cases， VSD combined with skin grafting） and PRP+VSD group （34 cases， PRP+VSD combined with skin grafting）. The clinical efficacy， incidence rate of complications， ulcer status （healing time， granulation tissue formation time， amputation rate）， ulcer area before surgery and at 1， 2 and 3 weeks after surgery， cytokines expressions （bFGF， TGF-β） before surgery and at 3 weeks after surgery and postoperative scar status （VSS） were compared between the two groups of patients. Results" Before skin grafting， the total effective rate in PRP+VSD group was 97.06%， which was higher than 81.82% in VSD group （P＜0.05）. The ulcer area in PRP+VSD group was lower than that in VSD group at 1， 2， and 3 weeks after VSD treatment （P＜0.05）. The granulation tissue formation time， healing time， and amputation rate in PRP+VSD group were lower than those in VSD group （P＜0.05）. At 3 weeks after VSD treatment， the expression levels of cytokines （bFGF and TGF-β） in the two groups were increased （P＜0.05）， and those in PRP+VSD group were higher than those in VSD group （P＜0.05）. There was no difference in the incidence of complications between the two groups （P＞0.05）. At 3 weeks after skin grafting， the total score and each item score of VSS in PRP+VSD group were lower than those in VSD group （P＜0.05）. Conclusion" PRP combined with vacuum sealing drainage and skin grafting can effectively treat diabetic foot ulcer， promote wound healing， and restore limb aesthetics， thus it is safe and effective.

Key words： diabetic foot ulcer;" platelet rich plasma（PRP）; vacuum sealing drainage（VSD）; skin grafting

糖尿病足即糖尿病患者因糖尿病所致下肢远端神经或血管病变导致的足部溃疡或深层组织破坏，并可能伴严重感染[1]。糖尿病足发病率较高，治疗难度大，是我国目前致残与致死率最高的糖尿病慢性并发症，该类患者常出现足部异常、畸形、缺血性坏死，严重者易合并感染、溃疡、坏疽。据统计，糖尿病足截肢率高达15%以上，严重影响患者的生活质量[2]。皮片移植术是糖尿病足皮肤缺损常见修复手术，其通过将人工皮片移植至患者下肢皮肤缺损部位，以有效恢复皮肤外观[3]。……