Winters Christopher L, Brigido Stephen A, Liden Brock A, Simmons Melitta, Hartman Jodi F, Wright Michelle L
American Health Network, Indianapolis, IN, USA.
Adv Skin Wound Care. 2008 Aug;21(8):375-81. doi: 10.1097/01.ASW.0000323532.98003.26.
This multicenter, retrospective study presents the use of a human acellular dermal regenerative tissue matrix as an alternative treatment for 100 chronic, full-thickness wounds of the lower extremity in 75 diabetic patients. Comorbidities included cardiac disease (86.0%), neuropathy (86.0%), peripheral vascular disease (82.0%), infection (54.0%), obesity (51.0%), and osteomyelitis (37.0%). Wound locations included the foot (86.0%), ankle (8.0%), and lower extremity (6.0%). Mean wound age was 20.4 weeks (1.3-191.4 weeks). University of Texas (UT) wound classifications included 15 (15.0%) 1A, 1 (1.0%) 1B, 1 (1.0%) 1C, 2 (2.0%) 1D, 18 (18.0%) 2A, 8 (8.0%) 2B, 5 (5.0%) 2C, 3 (3.0%) 2D, 3 (3.0%) 3A, 7 (7.0%) 3B, 3 (3.0%) 3C, and 34 (34.0%) 3D. The mean time to matrix incorporation, 100% granulation, and complete healing was 1.5 weeks (0.43-4.4 weeks), 5.1 weeks (0.43-16.7 weeks), and 13.8 weeks (1.7-57.8 weeks), respectively. The overall matrix success rate, as defined by full epithelialization, was 90.0%. One failed wound subsequently healed approximately 7 weeks after matrix reapplication. The healing rate was 91.0%, as 91 of the 100 wounds healed. No statistically significant differences were observed between UT classifications and time to matrix incorporation, 100% granulation, and complete healing. Absence of matrix-related complications and high rates of closure in a wide array of diabetic wounds suggest that this matrix is a viable treatment for complex lower extremity wounds. Lack of any statistically significant differences between UT grades and wound outcome end points lends further support to the universal applicability of this matrix, with successful results in both superficial diabetic wounds and in wounds penetrating to the bone or joint.
这项多中心回顾性研究介绍了使用人脱细胞真皮再生组织基质作为75例糖尿病患者100处慢性下肢全层伤口的替代治疗方法。合并症包括心脏病（86.0%）、神经病变（86.0%）、外周血管疾病（82.0%）、感染（54.0%）、肥胖（51.0%）和骨髓炎（37.0%）。伤口部位包括足部（86.0%）、踝部（8.0%）和下肢（6.0%）。伤口平均年龄为20.4周（1.3 - 191.4周）。德克萨斯大学（UT）伤口分类包括15处（15.0%）1A、1处（1.0%）1B、1处（1.0%）1C、2处（2.0%）1D、18处（18.0%）2A、8处（8.0%）2B、5处（5.0%）2C、3处（3.0%）2D、3处（3.0%）3A、7处（7.0%）3B、3处（3.0%）3C和34处（34.0%）3D。基质植入、100%肉芽形成和完全愈合的平均时间分别为1.5周（0.43 - 4.4周）、5.1周（0.43 - 16.7周）和13.8周（1.7 - 57.8周）。以完全上皮化定义的总体基质成功率为90.0%。一处失败的伤口在重新应用基质后约7周愈合。愈合率为91.0%，因为100处伤口中有91处愈合。在UT分类与基质植入时间、100%肉芽形成时间和完全愈合时间之间未观察到统计学上的显著差异。无基质相关并发症以及在各种糖尿病伤口中高闭合率表明，这种基质是治疗复杂下肢伤口的可行方法。UT分级与伤口结局终点之间缺乏任何统计学上的显著差异进一步支持了这种基质的普遍适用性，在浅表糖尿病伤口以及穿透至骨或关节的伤口中均取得了成功结果。
