Registrar Burns and Plastic Surgery, Queen Elizabeth Hospital, Birmingham, UK.
J Plast Reconstr Aesthet Surg. 2013 Dec;66(12):1717-24. doi: 10.1016/j.bjps.2013.07.007. Epub 2013 Jul 31.
Improvised explosive device (IED) blasts cause serious injury. Survivors are left with multiple amputations, considerable soft tissue loss and open fractures with gross contamination. We present our early experience of Integra™ in the acute management of military wounds.
The clinical records of all patients with IED injuries who underwent early reconstruction with Integra™ during the six month period between August and December 2009 in our unit were reviewed and data gathered prospectively.
There were 7 male soldiers, aged 21-31 years (mean=26). All sustained trunk and limb injuries, including multiple amputations. Number of procedures prior to application of Integra™ was 4-10 (mean=5). Application of Integra™ took place 6-24 days post-injury (mean=13). Size of wounds covered with Integra™ was 1-11.5% TBSA (mean=5%). Anatomical sites reconstructed included amputation stumps, and both upper and lower limbs. There was partial take of Integra in 3 wounds in 2 patients. All wounds were eventually treated with delayed split skin grafting and healed satisfactorily.
IEDs produce a large zone of injury with massive soft tissue damage, multiple discontinuous wounds which are significantly contaminated. The physiological insult is equivalent to a large cutaneous burn and there is a paucity of available donor sites. Multiple amputees also have a greater energy and power requirement(1-4) and cannot spare remaining functional muscles as donors. The literature suggests that microvascular flaps have a high failure rate in military patients.(5) Reconstruction began as soon as wounds were considered sufficiently clean. Integra™ was applied with the aim of providing higher quality coverage than that provided by split skin grafting alone (particularly for amputation stumps) whilst minimising operative time and morbidity. Integra™ allows timely closure of battlefield wounds with minimal operative time and morbidity. The procedure can begin whilst still in the acute phase and certainly before one would consider lengthy complex operations such as free flaps. Our experience suggests that Integra™ can allow early closure with robust tissue, promoting early rehabilitation and return to duties.
简易爆炸装置（IED）爆炸会导致严重伤害。幸存者会出现多处截肢、大量软组织缺失和开放性骨折，并伴有严重污染。我们介绍 Integra 在我们单位 2009 年 8 月至 12 月期间治疗军事创伤的早期经验。
回顾了我们单位在 6 个月期间内使用 Integra 早期重建的所有 IED 伤员的临床记录，并前瞻性地收集了数据。
共有 7 名 21-31 岁（平均 26 岁）的男性士兵，均有躯干和四肢损伤，包括多处截肢。在应用 Integra 之前，进行了 4-10 次手术（平均 5 次）。应用 Integra 的时间为伤后 6-24 天（平均 13 天）。用 Integra 覆盖的伤口面积为 1-11.5% TBSA（平均 5%）。重建的解剖部位包括截肢残端和上下肢。2 名患者的 3 个伤口出现 Integra 部分覆盖。所有伤口最终均行延迟皮片移植治疗，愈合满意。
IED 产生大面积损伤，伴有大量软组织损伤和多个不连续的污染伤口。生理损伤相当于大面积皮肤烧伤，可供选择的供体部位很少。多处截肢者还需要更大的能量和动力（1-4），无法将剩余的功能肌肉作为供体。文献表明，在军事患者中，微血管皮瓣的失败率很高。（5）一旦认为伤口足够清洁，就开始进行重建。应用 Integra 的目的是提供比单纯皮片移植更高质量的覆盖（尤其是对于截肢残端），同时尽量减少手术时间和发病率。Integra 可最大限度减少手术时间和发病率，及时闭合战场伤口。该手术可以在急性期进行，当然也可以在考虑进行游离皮瓣等复杂手术之前进行。我们的经验表明，Integra 可以提供坚固的组织，早期闭合伤口，促进早期康复和重返工作岗位。
