トラフェルミンを用いた難治性足部皮膚潰瘍の治療

Conservative Treatment of Intractable Foot Ulcer with Trafermin

　糖尿病や悪性腫瘍のため，全身状態が悪い患者に発生した足部皮膚潰瘍の治療には難渋することが多い．今回，全身状態が悪いため外科的治療が選択できない患者に発生した足背部皮膚潰瘍と，糖尿病性足趾壊疽の足趾切断術後創で感染のため開放とした症例を経験した．2症例とも植皮をせず，トラフェルミン（フィブラストスプレー^®）を使用して保存的に治癒し得た．治療は長期間に及ぶが，侵襲がなくADL制限を必要としないため，今回のような難治性足部皮膚潰瘍の治療に有用と思われた．

　Intractable foot ulcer in patients with severe diabetes or in poor general condition is particularly difficult to treat. We successfully treated an intractable foot ulcer in two such patients. In one patient the foot ulcer was secondary to gas gangrene. The patient had advanced hepatocellular carcinoma and could not be operated on because of his poor general condition. The foot ulcer in the other patient developed after fourth toe amputation for toe gangrene secondary to severe diabetes. Both cases were treated conservatively with trafermin (Fiblast spray^®). This method is less invasive and causes less limitation of daily life, but requires a long period of treatment. Trafermin is a good choice for conservative treatment of intractable foot ulcer.