Valerio Ian L, Masters Zachary, Seavey Jonathan G, Balazs George C, Ipsen Derek, Tintle Scott M
Departments of Plastic, Orthopedic, and General Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
Department of General Surgery, Keesler Medical Center, Biloxi, MS.
J Hand Surg Am. 2016 Dec;41(12):e453-e460. doi: 10.1016/j.jhsa.2016.08.015. Epub 2016 Oct 13.
To assess the outcomes of treatment with a dermal regeneration template (DRT) in a cohort of combat casualties with severe upper extremity injuries.
Records of all active duty military patients treated with DRT at our institution between November 2009 and July 2013 were screened. Inclusion criteria were upper extremity open wounds sustained during combat, requiring split-thickness or full-thickness skin grafting for closure. The primary outcome measure was wound healing after the first attempt at definitive treatment (defined as the first application of split-thickness or full-thickness skin graft). Independent variables collected included time from injury to arrival at our facility, mechanism of injury, wound infection, tobacco use, location of wound, number of operative debridements, and patient demographics.
A total of 60 patients with 69 wounds met the inclusion criteria. Most wounds were to the wrist or forearm (54%) or fingers (19%). All wounds were heavily contaminated, requiring a mean of 2.5 operative debridements before DRT placement. All wounds treated with full-thickness skin grafting after DRT healed completely without further complication. Split-thickness skin grafting was successful in 96% of patients.
DRT wound dressings are a helpful adjunct in the treatment of contaminated war wounds to the upper extremity.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
评估在一组上肢严重战伤伤员中使用真皮再生模板（DRT）的治疗效果。
筛选2009年11月至2013年7月间在我院接受DRT治疗的所有现役军人患者的记录。纳入标准为战斗期间上肢开放性伤口，需要进行中厚皮片或全厚皮片移植来闭合伤口。主要结局指标是首次确定性治疗（定义为首次应用中厚皮片或全厚皮片移植）后的伤口愈合情况。收集的自变量包括从受伤到抵达我院的时间、损伤机制、伤口感染、吸烟情况、伤口位置、手术清创次数以及患者人口统计学资料。
共有60例患者的69处伤口符合纳入标准。大多数伤口位于手腕或前臂（54%）或手指（19%）。所有伤口均严重污染，在放置DRT前平均需要进行2.5次手术清创。所有在DRT后接受全厚皮片移植治疗的伤口均完全愈合，无进一步并发症。中厚皮片移植在96%的患者中成功。
DRT伤口敷料是治疗上肢污染战伤的一种有用辅助手段。
研究类型/证据水平：治疗性IV级。
