Kahn Steven Alexander, Beers Ryan J, Lentz Christopher W
Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA.
J Burn Care Res. 2011 Jan-Feb;32(1):124-8. doi: 10.1097/BCR.0b013e318204b327.
Dermal templates are well established in the treatment of burn wounds and acute nonburn wounds. However, the literature regarding their use for reconstruction of chronic, nonhealing wounds is limited. This study describes a series of patients with chronic wounds reconstructed with a commercially available bilayer, acellular dermal replacement (ADR) containing a collagen-glycosaminoglycan dermal template and a silicone outer layer. A retrospective review was performed of 10 patients treated for chronic wounds with ADR and negative pressure dressing followed by split-thickness skin graft between July 2006 and January 2009. Data collected included age, gender, comorbidities, medications, wound type or location, wound size, the number of applications of ADR, the amount of ADR applied (in square centimeter), the amount of time between ADR placement and grafting, complications, need for reoperation, and percentage of graft take after 5 and 14 days. The mean age of study subjects was 44 years. All patients in the study had comorbidities that interfere with wound healing and were treated for lower extremity wounds (four to legs, five to ankles, and one to foot). The wounds had a variety of causative factors including venostasis ulcers (6, 60%), trauma in diabetic patients (2, 20%), brown recluse bite (1, 10%), and a wound caused from purpura fulminans (1, 10%). The average wound size and amount of ADR applied was 162±182 cm². Each patient required only one application of ADR. The average time between ADR placement and skin grafting was 36.5 days. The mean percentage of graft take at 5 days was 89.55%, 14 days was 90%, and 21 days was 87.3%. Only two patients required regrafting, and one of these grafts was lost because of patient noncompliance. ADR can be used successfully in the treatment of chronic wounds. ADR provides direct wound coverage and can conform to a variety of anatomical sites. This study demonstrates that the use of ADR in treating chronic wounds results in high rates of skin graft take. Favorable results were obtained despite the majority of patients having comorbidities that would normally interfere with wound healing.
真皮模板在烧伤创面和急性非烧伤创面的治疗中已得到广泛应用。然而，关于其用于慢性、不愈合创面修复的文献有限。本研究描述了一系列使用市售双层无细胞真皮替代物（ADR）进行慢性创面修复的患者，该替代物包含胶原 - 糖胺聚糖真皮模板和硅酮外层。对200年7月至2009年1月期间接受ADR和负压敷料治疗慢性创面，随后进行中厚皮片移植的10例患者进行了回顾性研究。收集的数据包括年龄、性别、合并症、用药情况、创面类型或位置、创面大小、ADR的应用次数、应用的ADR量（平方厘米）、ADR放置与移植之间的时间、并发症、再次手术需求以及5天和14天后皮片成活百分比。研究对象的平均年龄为44岁。研究中的所有患者均有影响创面愈合的合并症，且均为下肢创面（4例在腿部，5例在脚踝，1例在足部）。创面有多种致病因素，包括静脉淤滞性溃疡（6例，60%）、糖尿病患者创伤（2例，20%）、褐蛛咬伤（1例，10%）和暴发性紫癜所致创面（1例，10%）。平均创面大小和应用的ADR量为162±182平方厘米。每位患者仅需应用一次ADR。ADR放置与皮片移植之间的平均时间为36.5天。5天时皮片成活的平均百分比为89.55%，14天时为90%，21天时为87.3%。仅2例患者需要再次移植，其中1例移植皮片因患者不依从而丢失。ADR可成功用于慢性创面的治疗。ADR可直接覆盖创面，且能贴合多种解剖部位。本研究表明，ADR用于治疗慢性创面可使皮片成活率较高。尽管大多数患者有通常会影响创面愈合的合并症，但仍获得了良好的结果。
