Johns Hopkins University School of Medicine, Department of Plastic and Reconstructive Surgery, Baltimore, MD, USA.
J Plast Reconstr Aesthet Surg. 2012 Nov;65(11):1544-50. doi: 10.1016/j.bjps.2012.05.021. Epub 2012 Jun 20.
Soft tissue deficits associated with exposed tendon and absent paratenon pose difficult reconstructive problems due to tendon adhesions, poor range of motion, poor cosmesis, and donor site morbidity. Integra Bilayer Matrix Wound Dressing (Integra Lifesciences Corp Plainsboro, NJ) is a skin substitute widely used in reconstructive surgery, including the incidental coverage of tendons. However, Integra's post-operative functionality of the tendons has not been well documented. We report the results of using Integra for soft tissue reconstruction overlying tendons with loss of paratenon in upper and lower extremity soft tissue defects.
Forty-two patients (35 men and 7 women) with exposed tendons due to trauma (37), cancer excision (2) or chronic wounds (3) were reconstructed using Integra. Results were compiled in a prospective manner, including age, gender, wound location, wound size, time to final closure, operative time, follow-up length, split-thickness skin graft percentage take and active post-operative range of motion. Likewise using Medline, a literature search of current surgical techniques for the treatment of exposed tendons and the results from the literature were compared with these study results.
All patients healed with an average split-thickness skin graft take rate of 92.5% ± 6.1 (range, 80-100%). The thirty-two patients not lost to follow-up achieved an average range of motion of 91.2% ± 6.5 (range, 80-100%).
Integra offers a convenient, efficient operative procedure with minimal morbidity, demonstrating good cosmesis and tendon function. Thus, Integra may offer an alternative option for immediate tendon coverage in both the upper and lower extremities.
由于腱粘连、运动范围差、美容效果差和供体部位发病率高，与暴露的肌腱和不存在腱旁组织相关的软组织缺损带来了困难的重建问题。 Integra 双层基质创面敷料（Integra Lifesciences Corp Plainsboro，NJ）是一种广泛用于重建手术的皮肤替代品，包括意外覆盖肌腱。然而， Integra 术后肌腱的功能尚未得到很好的记录。我们报告了使用 Integra 在上下肢软组织缺损中覆盖失去腱旁组织的肌腱的软组织重建结果。
42 例（35 名男性和 7 名女性）因创伤（37 例）、癌症切除（2 例）或慢性伤口（3 例）导致暴露的肌腱患者使用 Integra 进行重建。前瞻性地收集结果，包括年龄、性别、伤口位置、伤口大小、最终闭合时间、手术时间、随访时间、中厚皮片移植百分比和主动术后运动范围。同样，通过 Medline 进行文献检索，比较了治疗暴露肌腱的当前手术技术的结果，并将这些研究结果与这些研究结果进行了比较。
所有患者均愈合，平均中厚皮片移植率为 92.5%±6.1（范围，80-100%）。32 例未失访的患者平均运动范围为 91.2%±6.5（范围，80-100%）。
Integra 提供了一种方便、高效的手术操作，具有最小的发病率，表现出良好的美容效果和肌腱功能。因此，Integra 可能为上下肢的即时肌腱覆盖提供了一种替代选择。
