Hom David B, Manivel J Carlos
Department of Otolaryngology--Head and Neck Surgery, University of Minnesota School of Medicine, Minneapolis 55455, USA.
Laryngoscope. 2003 Sep;113(9):1566-71. doi: 10.1097/00005537-200309000-00029.
OBJECTIVES/HYPOTHESIS: Persistent, poorly healing wounds are a significant clinical problem in patients who have had previous irradiation. Despite current treatments, refractory nonhealing soft tissue wounds persist. The study described one of the earliest reported uses of recombinant human platelet-derived growth factor-BB (rhPDGF) gel to improve the healing of a previously irradiated refractory dermal wound to the neck that had been present for 12 years.
Case report and literature review.
Review of local healing management of previously irradiated wounds and review of patients chart one year after follow-up treatment.
A 47-year-old man had a 12-year history of a persistent, painful, nonhealing full-thickness dermal wound on the left side of his neck after radiation therapy and chemotherapy for a T2N2bM0 nasopharyngeal carcinoma. He had been tumor free for 12 years. Despite multiple modalities of therapy over a 1-year period (including moist hydrogel dressings, topical and oral antibiotics, serial debridement, and hyperbaric oxygen), the wound did not heal. After 6 months of topical rhPDGF gel treatment, sufficient granulation tissue developed within the dermal wound that a split-thickness skin graft was successfully performed. Symptomatically, the patient's continuous pain at the neck resolved after rhPDGF treatment. Serial histological biopsy specimens before and after rhPDGF treatment confirmed the wound transformation from a chronic state to a short-term healing state.
In previously irradiated tissue, rhPDGF can be useful in helping refractory wounds to heal by inducing further granulation formation. If such treatment is planned, the patient should be informed of the possible theoretical risks of its use when it is in proximity to a previously treated neoplastic site.
目的/假设：对于曾接受过放疗的患者而言，持续性、愈合不佳的伤口是一个重大的临床问题。尽管有当前的治疗方法，但难治性不愈合软组织伤口仍然存在。本研究描述了重组人血小板衍生生长因子-BB（rhPDGF）凝胶最早报道的用途之一，即用于改善一例颈部先前接受过放疗的难治性皮肤伤口的愈合情况，该伤口已存在12年。
病例报告及文献综述。
回顾先前接受过放疗伤口的局部愈合管理情况，并在随访治疗一年后查阅患者病历。
一名47岁男性在接受T2N2bM0鼻咽癌放疗和化疗后，左侧颈部有一个持续12年疼痛不愈合的全层皮肤伤口。他已无瘤12年。尽管在1年期间采用了多种治疗方式（包括湿性水凝胶敷料、局部和口服抗生素、系列清创术以及高压氧治疗），伤口仍未愈合。在局部应用rhPDGF凝胶治疗6个月后，真皮伤口内形成了足够的肉芽组织，成功进行了中厚皮片移植。症状方面，患者颈部的持续疼痛在rhPDGF治疗后缓解。rhPDGF治疗前后的系列组织学活检标本证实伤口从慢性状态转变为短期愈合状态。
在先前接受过放疗的组织中，rhPDGF可通过诱导进一步肉芽组织形成，帮助难治性伤口愈合。如果计划进行此类治疗，应告知患者在其靠近先前治疗过的肿瘤部位使用时可能存在的理论风险。
