Santiago Gabriel F, Bograd Benjamin, Basile Patrick L, Howard Robert T, Fleming Mark, Valerio Ian L
Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
Ann Plast Surg. 2012 Oct;69(4):418-21. doi: 10.1097/SAP.0b013e31824a4584.
Blast exposure is a common cause of soft tissue injury within the battlefield setting, with the extremities often critically involved. The resulting injury pattern presents with massive soft tissue defects that may be further complicated by varying degrees of accompanying orthopedic and peripheral nerve damage. To address the severe soft tissue defect, various combinations of advanced reconstructive methods are typically required to achieve definitive wound coverage. Continuous external tissue expansion has been used by our institution to significantly reduce wound burden and provide for definitive wound closure in certain blast-injured patients.
The authors present an early series of 14 patients who suffered massive extremity soft tissue injuries and were treated with an external tissue expansion system (DermaClose RC). Outcome measurements included time to definitive closure and method of definitive wound closure. A 5-patient subset of this group was prospectively analyzed to determine measurements including initial wound surface area (WSA), percentage reduction in WSA, and related complications.
Overall time to wound coverage ranged from 1 to 6 days, with mean time to wound coverage being 4.4 days. Of the 14 patients included in the series, 12 (85.7%) were able to undergo delayed primary closure, whereas 2 required split thickness skin grafting. In the 5-patient subgroup, WSA initially ranged from 20.25 to 1031.25 cm2. Mean wound size was 262.7 cm2. Decrease in WSA ranged from 44% to 93% of the initial WSA, with mean decrease being 74.3% (95% confidence interval, 57.33-91.3).
In the management of large complex wounds, external tissue expansion has proven to be a valuable adjunct in achieving definitive wound closure. It can often aid in successful delayed primary closure of certain soft tissue wounds, has low associated morbidities, and can reduce the need for more complex or morbid procedures when used properly. The authors propose an algorithm for the use of continuous external tissue expansion system to achieve effective and successful wound closure, while potentially reducing the need for increased donor-site morbidities associated with more complex or larger reconstruction measures.
在战场环境中，爆炸暴露是软组织损伤的常见原因，四肢常受到严重影响。由此产生的损伤模式表现为巨大的软组织缺损，可能因不同程度的伴随骨科和周围神经损伤而进一步复杂化。为了处理严重的软组织缺损，通常需要各种先进重建方法的组合来实现确定性的伤口覆盖。我们机构使用持续外部组织扩张来显著减轻伤口负担，并为某些爆炸伤患者实现确定性的伤口闭合。
作者介绍了早期的一组14例患者，他们遭受了严重的四肢软组织损伤，并接受了外部组织扩张系统（DermaClose RC）治疗。结果测量包括确定性闭合的时间和确定性伤口闭合的方法。对该组中的5例患者进行前瞻性分析，以确定包括初始伤口表面积（WSA）、WSA减少百分比及相关并发症等测量指标。
伤口覆盖的总时间为1至6天，伤口覆盖的平均时间为4.4天。该系列纳入的14例患者中，12例（85.7%）能够进行延迟一期闭合，而2例需要进行中厚皮片移植。在5例患者的亚组中，WSA最初范围为20.25至1031.25平方厘米。平均伤口大小为262.7平方厘米。WSA的减少范围为初始WSA的44%至93%，平均减少为74.3%（95%置信区间，57.33 - 91.3）。
在大型复杂伤口的处理中，外部组织扩张已被证明是实现确定性伤口闭合的有价值辅助手段。它通常有助于某些软组织伤口成功进行延迟一期闭合，相关发病率低，并且在正确使用时可减少对更复杂或更具创伤性手术的需求。作者提出了一种使用持续外部组织扩张系统实现有效且成功伤口闭合的算法，同时可能减少与更复杂或更大重建措施相关的供区发病率增加的需求。
