Dorman Robert M, Bass Kathryn D
Department of Surgery, State University of New York at Buffalo, Buffalo, NY, USA.
Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, 219 Bryant St., Buffalo, NY, 14209, USA.
Pediatr Surg Int. 2016 Oct;32(10):997-1002. doi: 10.1007/s00383-016-3915-0. Epub 2016 Jul 2.
Extracellular matrix is used in various applications. We present our preliminary experience using a new device that consists of a porcine extracellular matrix with an epithelial basement membrane (MatriStem(®), ACell, Inc. Columbia, MD, USA) for adolescent pilonidal disease.
A retrospective review of four patients with pilonidal disease was undertaken. Three occurred in the gluteal cleft, and the fourth in the umbilicus. In the first patient, the wound deficit was filled with lyophilized MicroMatrix powder and a sheet of Multilayer Wound Matrix was placed to cover the wound. In the second patient, two sinus tracts were debrided, packed with MicroMatrix, and a sheet of fenestrated Burn Matrix was applied. In the third patient, MicroMatrix and Surgical Matrix PSMX (six-layer) was applied as a roll filling the dead space. In the last patient, an umbilical sinus 3 cm deep was packed with MicroMatrix powder followed by a rolled sheet of 2-ply Surgical Matrix RS. Patients were evaluated weekly post-operatively, and more MicroMatrix and sheet material was added if a wound deficit was still present. Measurements were taken in two dimensions, diameter and depth, to characterize wounds.
Resolution of wound deficit was graphed versus time. Pain was assessed by scoring 0-10. Rapid wound closure was achieved. Two of the patients had failed wound healing with saline dressing changes prior to MatriStem application. These two patients in particular were highly satisfied with the comfort of the MatriStem approach relative to their time with saline dressings. Most had no pain after 1 week when bolster sutures were removed.
In the treatment of open pilonidal wounds in adolescents, porcine urinary bladder matrix wound care devices offer closure times and cost similar to well-established methods while offering a substantial advantage in terms of patient comfort and convenience. This preliminary experience supports a prospective study.
细胞外基质被用于各种应用中。我们展示了使用一种新装置的初步经验，该装置由带有上皮基底膜的猪细胞外基质（MatriStem®，ACell公司，美国马里兰州哥伦比亚）组成，用于治疗青少年藏毛疾病。
对4例藏毛疾病患者进行回顾性研究。3例发生在臀裂，第4例发生在脐部。在第1例患者中，用冻干的MicroMatrix粉末填充伤口缺损，并放置一片多层伤口基质覆盖伤口。在第2例患者中，清创两条窦道，用MicroMatrix填充，并应用一片有孔的烧伤基质。在第3例患者中，将MicroMatrix和外科基质PSMX（六层）作为一卷应用以填充死腔。在最后一例患者中，用MicroMatrix粉末填充一个3厘米深的脐部窦道，随后用一卷双层外科基质RS覆盖。术后每周对患者进行评估，如果仍存在伤口缺损，则添加更多的MicroMatrix和片状材料。在两个维度上进行测量，即直径和深度，以描述伤口特征。
绘制伤口缺损分辨率与时间的关系图。通过0至10分评分评估疼痛。实现了快速伤口闭合。其中2例患者在应用MatriStem之前用生理盐水换药时伤口愈合失败。这两名患者尤其对MatriStem方法相对于使用生理盐水敷料时的舒适度非常满意。大多数患者在1周后拆除支撑缝线时没有疼痛。
在治疗青少年开放性藏毛伤口时，猪膀胱基质伤口护理装置的愈合时间和成本与成熟方法相似，但在患者舒适度和便利性方面具有显著优势。这一初步经验支持进行前瞻性研究。
