Canonico Silvestro, Campitiello Ferdinando, Della Corte Angela, Fattopace Andrea
Department of Gerontology and Geriatrics, Section of Surgery, Second University of Naples, Naples, Italy.
Dermatol Surg. 2009 Feb;35(2):195-200. doi: 10.1111/j.1524-4725.2008.34409.x.
In some chronic leg ulcers, a reconstructive operation using skin grafts may be extremely difficult or is quite likely to fail as a result of the position, the width, and the depth of the lesions.
To evaluate the effectiveness of a dermal substitute and thin skin grafts in the treatment of patients suffering from deep and wide chronic leg ulcers.
MATERIALS & METHODS: Twenty-six consecutive patients with leg ulcers at least 1 year old were admitted to the study. The ulcers were large (>100 cm2) and deep (>3 mm) over at least 50% of the surface area. After surgical debridement of the wounds, the dermal matrix was modeled and applied. After 21 days, the attachment of the artificial dermis was tested, and in positive cases, the patient was re-admitted for "thin" skin grafting.
In all patients, at the first follow-up, a notable reduction in pain, exudate, and perilesional edema was ascertained. After 2 weeks, the progressive substitution of granulation tissue with new yellow or gold derma became evident in all patients. After 21 days, the dermal matrix was completely integrated with the guest tissue. In 23 patients (88.5%), attachment of the skin graft was complete, and in three patients (11.5%), it was partial but nevertheless larger than 70% of the surface. Even in these cases, complete healing of the lesions was achieved within 4 weeks at most. All patients were checked for a minimum of 3 months, and none suffered an ulcerous recurrence.
In our series, the use of this dermal matrix allowed for the complete refilling of the loss of tissue, the rapid disappearance of pain, and the rapid regeneration of a permanent dermis.
在一些慢性腿部溃疡中，由于病变的位置、宽度和深度，使用皮肤移植进行重建手术可能极其困难或很可能失败。
评估一种真皮替代物和薄皮移植治疗深部和广泛慢性腿部溃疡患者的有效性。
连续纳入26例患有至少1年病史的腿部溃疡患者进行研究。溃疡面积大（>100 cm²）且深（>3 mm），至少占表面积的50%。伤口进行手术清创后，塑造并应用真皮基质。21天后，测试人工真皮的附着情况，在阳性病例中，患者再次入院进行“薄”皮移植。
在所有患者的首次随访中，确定疼痛、渗出物和病灶周围水肿显著减轻。2周后，所有患者均明显可见肉芽组织逐渐被新的黄色或金色真皮替代。21天后，真皮基质与宿主组织完全整合。23例患者（88.5%）皮移植附着完全，3例患者（11.5%）附着部分但仍大于表面积的70%。即使在这些病例中，病灶最多在4周内完全愈合。所有患者至少接受了3个月的检查，无一例溃疡复发。
在我们的系列研究中，使用这种真皮基质能够使组织缺损完全填充，疼痛迅速消失，永久性真皮快速再生。
