Brem H, Balledux J, Bloom T, Kerstein M D, Hollier L
Department of Surgery, The Mount Sinai Medical Center, New York, NY 10029-6574, USA.
Arch Surg. 2000 Jun;135(6):627-34. doi: 10.1001/archsurg.135.6.627.
In patients with diabetic foot and pressure ulcers, early intervention with biological therapy will either halt progression or result in rapid healing of these chronic wounds.
In a prospective nonrandomized case series, 23 consecutive patients were treated with human skin equivalent (HSE) after excisional debridement of their wounds.
A single university teaching hospital and tertiary care center.
Twenty-three consecutive patients with a total of 41 wounds (1.0-7.5 cm in diameter) were treated with placement of HSE after sharp excisional debridement. All patients with pressure ulcers received alternating air therapy with zero-pressure alternating air mattresses.
Time to 100% healing, as defined by full epithelialization of the wound and by no drainage from the site.
Seven of 10 patients with diabetic foot ulcers had complete healing of all wounds. In these patients 17 of 20 wounds healed in an average of 42 days. Seven of 13 patients with pressure ulcers had complete healing of all wounds. In patients with pressure ulcers, 13 of 21 wounds healed in an average of 29 days. All wounds that did not heal in this series occurred in patients who had an additional stage IV ulcer or a wound with exposed bone. Twenty-nine of 30 wounds that healed did so after a single application of the HSE.
In diabetic ulcers and pressure ulcers of various durations, the application of HSE with the surgical principles used in a traditional skin graft is successful in producing healing. The high success rate with complete closure in these various types of wounds suggests that HSE may function as a reservoir of growth factors that also stimulate wound contraction and epithelialization. If a wound has not fully healed after 6 weeks, a second application of HSE should be used. If the wound is not healing, an occult infection is the likely cause. All nonischemic diabetic foot and pressure ulcers that are identified and treated early with aggressive therapy (including antibiotics, off-loading of pressure, and biological therapy) will not progress.
在患有糖尿病足和压疮的患者中，早期采用生物疗法进行干预将阻止病情进展或使这些慢性伤口迅速愈合。
在一项前瞻性非随机病例系列研究中，23例连续患者在伤口切除清创术后接受了人皮肤替代物（HSE）治疗。
一家大学教学医院及三级护理中心。
23例连续患者共有41处伤口（直径1.0 - 7.5厘米），在锐利切除清创术后接受了HSE植入治疗。所有压疮患者均使用零压力交替气床垫进行交替空气疗法。
伤口完全愈合的时间，定义为伤口完全上皮化且伤口部位无渗液。
10例糖尿病足溃疡患者中有7例所有伤口完全愈合。在这些患者中，20处伤口中的17处平均在42天内愈合。13例压疮患者中有7例所有伤口完全愈合。在压疮患者中，21处伤口中的13处平均在29天内愈合。本系列中所有未愈合的伤口均出现在患有额外IV期溃疡或有暴露骨头伤口的患者中。30处愈合的伤口中有29处在单次应用HSE后愈合。
在不同病程的糖尿病溃疡和压疮中，按照传统皮肤移植手术原则应用HSE成功实现了伤口愈合。这些不同类型伤口的高完全闭合成功率表明，HSE可能作为生长因子的储存库，还能刺激伤口收缩和上皮化。如果伤口在6周后仍未完全愈合，应再次应用HSE。如果伤口未愈合，可能的原因是隐匿性感染。所有早期通过积极治疗（包括抗生素、减压和生物疗法）识别并治疗的非缺血性糖尿病足和压疮不会进展。
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