Chen Tiffany A, Ayala-Haedo Juan A, Blessing Nathan W, Topping Katie, Alabiad Chrisfouad R, Erickson Benjamin P
a School of Medicine, Stanford University , Stanford , California , USA.
b South Florida Eye Institute , Tamarac , Florida , USA.
Orbit. 2018 Apr;37(2):115-120. doi: 10.1080/01676830.2017.1367014. Epub 2017 Sep 11.
Traumatic periocular injuries occasionally result in significant soft tissue loss, for which there are limited management options that provide satisfactory cosmetic and functional outcomes. The authors describe the use of a bioengineered dermal substitute (Integra® Dermal Regeneration Template [DRT], Integra LifeSciences, Plainsboro, NJ) as an alternative to immediate flap reconstruction or skin grafting.
Retrospective interventional case series of patients who underwent DRT placement for periocular tissue loss at the time of trauma. In each case, primary closure or immediate flap reconstruction was deemed impractical or undesirable due to the size and location of the primary and associated secondary defects. One to four weeks later, the outer silicone layer was removed and healing assessed. Additional reconstructive techniques were performed as needed.
Three patients were treated at Bascom Palmer Eye Institute and one at Byers Eye Institute at Stanford. The defects healed completely in two patients, and by 79.2% in a third, with no need for additional reconstructive surgery. In the remaining patient, the defect was significantly downsized by 56.1%, allowing for a simpler flap reconstruction.
Bioengineered dermal substitutes should be considered as a viable alternative to traditional reconstructive techniques for large periocular defects resulting from trauma. The outer silicone layer prevents desiccation and serves as a protective barrier, while the inner collagen matrix organizes the growth of neo-dermis and minimizes wound contraction. The dimensions of cutaneous defects can therefore be reduced dramatically, potentially eliminating the need for skin grafting and/or reducing the ultimate complexity of flap reconstruction.
创伤性眼周损伤偶尔会导致严重的软组织缺失，针对这种情况，能够提供令人满意的美容和功能效果的治疗选择有限。作者描述了使用一种生物工程真皮替代物（Integra® 真皮再生模板 [DRT]，Integra LifeSciences公司，新泽西州普林斯顿）作为即刻皮瓣重建或皮肤移植的替代方法。
对因创伤导致眼周组织缺失而接受DRT植入的患者进行回顾性介入病例系列研究。在每例病例中，由于原发和相关继发缺损的大小及位置，一期缝合或即刻皮瓣重建被认为不切实际或不可取。1至4周后，去除外层硅胶层并评估愈合情况。根据需要进行额外的重建技术。
3例患者在巴斯科姆·帕尔默眼科研究所接受治疗，1例在斯坦福大学拜尔斯眼科研究所接受治疗。2例患者的缺损完全愈合，第3例患者的缺损愈合率达到79.2%，无需进行额外的重建手术。在其余1例患者中，缺损显著缩小了56.1%，使得皮瓣重建更为简单。
对于创伤导致的大型眼周缺损，生物工程真皮替代物应被视为传统重建技术的可行替代方法。外层硅胶层可防止干燥并起到保护屏障的作用，而内层胶原基质可促进新真皮的生长并使伤口收缩最小化。因此，皮肤缺损的尺寸可大幅减小，有可能无需进行皮肤移植和/或降低皮瓣重建的最终复杂性。
