Off-loading 減壓-FFD

游朝慶 醫師

   felted foam dressing(FFD，羊毛氈泡棉敷料，例如一種商品¹含有0.635公分厚的乳膠泡棉，結合一層0.158公分有黏性的羊毛氈，彼此以膠黏在一起)是一種裁剪好空洞，背後有膠可直接貼到足底部的羊毛氈(orthopaedic felt，原料可能是羊毛，人造纖維或綿，通常用來作為石膏或副木的護墊)，有一點像特力屋賣的防止家具刮傷地板，貼在家具腳柱底部的護墊，如下圖，國外有些是是用來治療或防止雞眼用的。

圖1.felted foam dressing, $0.49 tax incl. http://www.performancefoot.com/208-u-shaped-pad-felt-foam.html

圖2.家具用的防刮羊毛氈
   這種羊毛氈敷料可保護足底傷口，將傷口處的壓力轉移到傷口旁邊的皮膚¹，依個禮拜更換一次，根據Cavanagh的資料^2,3，FFD搭配post-OP shoe時，可降低傷口處48%的壓力(如下表)，且和TCC相比，其可以每天看到傷口並換藥，容易安裝，也可以和特製鞋或TCC，RCW搭配，Zimny等人的研究指出⁴，和傳統敷料相比，其可讓傷口1平方公分傷口的癒合時間從85天縮短到75天。Birke等人指出⁵，在前足的糖尿病足部傷口，FFD甚至可以達到TCC同等的療效，有8-9成的患者都可在12周內癒合。而且在有傷口感染或有血管病變的患者也可使用，不過，還是需要搭配特製鞋( post-op shoe)或鞋墊使用。

表1.the off-loading capacity of different modalities used for the prevention and treatment of diabetic plantar foot ulcers is expressed as percentage of peak pressure reduction at the first metatarsal head region compared with a control condition. The lighter bars show the range in measured peak pressure reduction over different studies.^2,3
   而相似於FFD，還有另一種輔具叫做Felt padding羊毛氈墊(felt deflective padding)，商品如下：可自由剪裁。

圖3.Felt padding, 22x15cm Price: £5.99   http://www.yourfootcare.com/chiropody-felt-7mm
   使用範例如下:
  

圖4.Application of felt padding⁶
1. Zimny S, Reinsch B, Schatz H, Effects of Felted Foam on Plantar Pressures in the Treatment of Neuropathic Diabetic Foot Ulcers, Diabetes Care. 2001 Dec;24(12):2153-4.
2. Peter R. Cavanagh , Sicco A. Bus, Off-loading the Diabetic Foot for Ulcer Prevention and Healing J. Am. Podiatr. Med. Assoc. 2010 100:360-368
3. Cavanagh PR, Bus SA.,Off-loading the diabetic foot for ulcer prevention and healing. J Vasc Surg. 2010 Sep;52(3 Suppl):37S-43S. doi: 10.1016/j.jvs.2010.06.007. Review
4. Zimny S, Schatz H, Pfohl U., The effects of applied felted foam on wound healing and healing times in the therapy of neuropathic diabetic foot ulcers, Diabetic Medicine, Volume 20, Issue 8, pages 622–625, August 2003
5. Birke JA, Pavich MA, Patout CA Jr, Horswell R. Comparison of forefoot ulcer healing using alternative off-loadingmethods in patients with diabetes mellitus. Adv Skin WoundCare 2002;15(5):210-5.
6. Shan M Bergin, management of diabetes related foot ulcers,演講ppt,2012  http://sehpa.com.au/wp-content/uploads/2012/05/GP-sessionmod-082011.1567.pdf