Alet Jean-Maxime, Weigert Romain, Castede Jean-Claude, Casoli Vincent
Plastic and Burn Surgery Department, FX Michelet Center, Bordeaux Hospital, Bordeaux Segalen University, Place Amelie Raba Leon, 33076 Bordeaux, France.
Injury. 2014 Jul;45(7):1042-8. doi: 10.1016/j.injury.2013.11.034. Epub 2013 Dec 13.
Traumatic soft tissue defect is a common issue for the trauma surgeon. The aim of this study was to evaluate the use of a dermal regeneration template (DRT) associated to a split-thickness skin graft (STSG) to cover severe traumatic wounds involving exposure of deep functional structures.
Patients with severe traumatic defects, either open fractures or full-thickness skin wounds involving exposure of tendons without paratenon, bones without periosteum or joints without articular capsule, managed in the authors' trauma centre, were included in a prospective fashion. They were treated by DRT, associated to STSG within a month and followed up to 18 months. The primary outcome was STSG percentage of take at 18 months. The secondary outcomes included complications rate, functional results, scar retraction rate at 18 months and aesthetic results.
A total of 15 patients were included, with 100% follow-up at 18 months. The mean age was 44.3 years, with nine men. Eighty percent of the wounds were located on the lower limb. After 18 months, the mean STSG take rate was 99.3%. Between the placement of the template and the STSG procedure, the reported complications were template unsticking, seroma, local infection and local oedema. There was no reported haematoma. In terms of functional outcome, percentages of patients undergoing rehabilitation from the time of the skin graft until the end of the follow-up decreased from 80% to 20%. There was 8.7% of retraction in length, and an 8.2% retraction in width. The Vancouver Scar Scale score constantly decreased until 2.5 at 18 months. The final functional and aesthetic subjective scores showed the marks to be located above the 'Satisfying' threshold, either by the surgeon or by the patients.
Eighteen months' follow-up demonstrated that DRT reconstruction is a simple, reliable, efficient tool to treat complex traumatic soft tissue defects.
创伤性软组织缺损是创伤外科医生面临的常见问题。本研究的目的是评估真皮再生模板（DRT）联合中厚皮片移植（STSG）用于覆盖涉及深部功能结构暴露的严重创伤伤口的效果。
前瞻性纳入在作者所在创伤中心接受治疗的患有严重创伤性缺损的患者，包括开放性骨折或全层皮肤伤口，伴有肌腱无腱旁组织暴露、骨无骨膜暴露或关节无关节囊暴露。他们接受了DRT治疗，并在1个月内联合STSG，随访18个月。主要结局是18个月时STSG的成活百分比。次要结局包括并发症发生率、功能结果、18个月时的瘢痕挛缩率和美学效果。
共纳入15例患者，18个月时随访率为100%。平均年龄为44.3岁，男性9例。80%的伤口位于下肢。18个月后，STSG的平均成活率为99.3%。在放置模板和进行STSG手术之间，报告的并发症有模板脱落、血清肿、局部感染和局部水肿。未报告有血肿。在功能结局方面，从植皮时到随访结束接受康复治疗的患者百分比从80%降至20%。长度挛缩率为8.7%，宽度挛缩率为8.2%。温哥华瘢痕量表评分在18个月时持续下降至2.5。最终的功能和美学主观评分显示，无论是外科医生还是患者给出的评分均高于“满意”阈值。
18个月的随访表明，DRT重建是治疗复杂创伤性软组织缺损的一种简单、可靠、有效的工具。
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