Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA.
Spine (Phila Pa 1976). 2011 Apr 15;36(8):E563-7. doi: 10.1097/BRS.0b013e3181f4a6bb.
Case series.
To illustrate the use of acellular dermal matrix (ADM) in treatment and prevention of exposed vertical expandable prosthetic titanium rib (VEPTR) implants.
In the pediatric population with severe kyphoscoliosis, VEPTR is an effective tool during growth for the correction of ribcage deformity. Prolonged VEPTR therapy can result in wound breakdown, implant exposure, and infection. Treatment includes the use of prolonged antibiotics, muscle flaps, and, when salvage fails, removal of the VEPTR. The use of ADM in the treatment and prevention of VEPTR exposure has not been previously described.
Between January 2002 and January 2010, eight patients who underwent placement of ADM for the treatment and prevention of exposed VEPTR devices were identified. Their records were reviewed for diagnosis, sex, age of patient at initial VEPTR placement, position of VEPTR placement, number of VEPTR expansions, wound complications, ADM use, adjunct procedures, and length of wound follow-up.
ADM was used in eight patients. In five patients ADM was used for compromised soft tissue overlying the VEPTR and threatened exposure of the hardware. In these cases, subsequent expansions occurred without incident and the wound remained stable with an average follow-up of 7.6 months. In three patients, ADM was used for exposed VEPTR hardware secondary to wound breakdown. Average follow-up was 3.3 months. In two of the three cases of exposed and contaminated hardware, stable soft tissue coverage was achieved and continued VEPTR therapy was achieved. One of the three cases of exposure involved infected and prominent hardware with purulence. This patient failed to clear the infection and required complete device removal.
ADM can treat and prevent exposed VEPTR, allowing subsequent VEPTR expansions and minimizing the need for muscle flap coverage and/or implant removal and replacement.
病例系列。
说明脱细胞真皮基质 (ADM) 在治疗和预防暴露式可扩张性假体钛肋骨 (VEPTR) 植入物中的应用。
在患有严重脊柱侧后凸的儿科人群中，VEPTR 是一种在生长过程中用于矫正胸廓畸形的有效工具。长时间的 VEPTR 治疗可能导致伤口破裂、植入物暴露和感染。治疗包括长期使用抗生素、肌肉皮瓣，如果治疗失败，则移除 VEPTR。ADM 在治疗和预防 VEPTR 暴露方面的应用尚未被描述过。
在 2002 年 1 月至 2010 年 1 月期间，确定了 8 名接受 ADM 治疗和预防暴露式 VEPTR 装置的患者。回顾他们的记录，以了解诊断、性别、初次 VEPTR 放置时患者的年龄、VEPTR 放置的位置、VEPTR 扩张的次数、伤口并发症、ADM 使用、辅助手术以及伤口随访的时间。
8 名患者使用了 ADM。在 5 名患者中，ADM 用于覆盖 VEPTR 上方受损的软组织并防止硬件暴露。在这些情况下，后续的扩张没有发生问题，并且在平均 7.6 个月的随访中，伤口保持稳定。在 3 名患者中，ADM 用于治疗因伤口破裂而暴露的 VEPTR 硬件。平均随访时间为 3.3 个月。在 3 例暴露和污染硬件的病例中，有 2 例稳定的软组织覆盖，并且继续进行 VEPTR 治疗。在 3 例暴露的病例中，有 1 例涉及感染和突出的硬件并伴有脓液。该患者未能清除感染，需要完全移除设备。
ADM 可治疗和预防暴露式 VEPTR，允许随后进行 VEPTR 扩张，并最大限度地减少对肌肉皮瓣覆盖和/或植入物移除和更换的需求。
