Liming Liu, Qian Gao, Dongxu Zou, Jingang Liu, Feilong Xiang, Hongyan Liao, Yaping Liu, Linjun Tang, Xianhe Li
The combination of PMMA bone cement and deep fascial release significantly accelerates DFU healing, reduces pain, and lowers recurrence risk through mechanisms of microcirculation reconstruction and nerve decompression. This integrated strategy offers an effective adjunctive treatment for refractory DFU, although its long-term efficacy requires further validation in prospective studies.
OBJECTIVE: Diabetic foot ulcers (DFU) are a serious complication of type 2 diabetes. For Wagner grade 2-4 ulcers, whichinvolve deep infection and microcirculatory impairment, conventional negative pressure wound therapy often produces suboptimal results. This study aimed to evaluate the clinical efficacy of the polymethylmethacrylate (PMMA) bone cement-induced membrane technique combined with deep fascial release in treating refractory DFU.
METHODS: In this propensity score-matched cohort analysis, 138 patients with Wagner grade 2-4 DFU were enrolled, divided into a PMMA group (n = 69) and a control group (n = 69). The PMMA group underwent deep fascial release followed by subcutaneous tunnel implantation of PMMA bone cement in the distal medial intermuscular space of the tibia, with removal at 8 weeks. The control group received conventional debridement and vacuum sealing drainage (VSD). Primary outcome measures included wound healing rate, healing time, dorsal foot skin temperature, Visual Analog Scale (VAS) score, ulcer recurrence rate, and frequency of debridement procedures.
RESULTS: The PMMA group achieved a 100% wound healing rate, significantly exceeding the control group (P < 0.001). The mean healing time was notably shorter in the PMMA group (34.81±3.56 days). Postoperative dorsal foot skin temperature was higher in the PMMA group (36.06 ± 0.24 °C vs. 35.36 ± 0.41 °C, P < 0.001), and VAS scores were significantly lower (1.41 ± 1.07 vs. 4.60 ± 0.74, P < 0.001). Additionally, the PMMA group showed better outcomes in secondary indicators, including ulcer recurrence rate (8.70%vs. 39.13%, P < 0.001) and number of debridement procedures (1.29 ± 0.67 vs. 2.64 ± 0.61, P < 0.001).
CONCLUSION: The combination of PMMA bone cement and deep fascial release significantly accelerates DFU healing, reduces pain, and lowers recurrence risk through mechanisms of microcirculation reconstruction and nerve decompression. This integrated strategy offers an effective adjunctive treatment for refractory DFU, although its long-term efficacy requires further validation in prospective studies.