Paredes J A, Bhagwandin S, Polanco T, Lantis J C
Vascular Wound Repair and Research Fellow, Department of Surgery, Mount Sinai St. Luke's-West Hospitals, New York, US.
Clinical Research Manager, Department of Surgery, Mount Sinai St. Luke's-West Hospitals, New York, US.
J Wound Care. 2017 Oct 1;26(Sup10):S12-S19. doi: 10.12968/jowc.2017.26.Sup10.S12.
As compression treatment offers moderate improvement, especially to recurrent venous leg ulcers (VLUs), several alternative therapies using cellular based and/or tissue-derived products (CTPs) have emerged from bovine, porcine, and equine sources. Our aim was to look at the effect of a CTP in 'real-life' VLUs.
This study looked at complex patients with chronic, large wounds in a single-centre retrospective review. All patients were treated with fetal bovine acellular dermal matrix (FBADM) for VLUs at our outpatient urban wound care programme.
A total of 40 wounds in 33 patients were analysed. At week four, 6% of wounds were closed; at week eight, 9% were closed; at week 12, 25% were closed; and at week 16, 38% of wounds were closed. The median time to wound closure was 67 days (range: 23-100 days) and the median percent wound closure through re-epithelialisation was 11% per week (range: 7-30% per week). At 4 weeks the median area reduction of all wounds was 23.5%, with 40% of VLUs having a ≥40% area reduction at the same point in time.
There are limitations to any retrospective review; however; patients deemed to have a limited chance of closure at 4 months did better than expected, either healing or having a wound area reduction at 16 weeks, making their wound care much easier. Prospective studies should be conducted to optimise the treatment algorithm to determine if better clinical outcomes can be obtained for the 'real-life' VLU population.
由于压迫治疗仅能带来适度改善，尤其是对复发性下肢静脉溃疡（VLU）而言，因此出现了几种使用基于细胞和/或组织衍生产品（CTP）的替代疗法，这些产品来源于牛、猪和马。我们的目的是研究CTP在“实际生活”中的VLU治疗效果。
本研究通过单中心回顾性分析观察患有慢性、大面积伤口的复杂患者。所有患者在我们城市门诊伤口护理项目中均接受了胎牛脱细胞真皮基质（FBADM）治疗VLU。
共分析了33例患者的40处伤口。在第4周时，6%的伤口愈合；第8周时，9%的伤口愈合；第12周时，25%的伤口愈合；第16周时，38%的伤口愈合。伤口愈合的中位时间为67天（范围：23 - 100天），通过上皮再形成实现的伤口愈合中位百分比为每周11%（范围：每周7% - 30%）。在4周时，所有伤口的中位面积缩小率为23.5%，40%的VLU在同一时间点面积缩小≥40%。
任何回顾性分析都存在局限性；然而，那些在4个月时被认为愈合可能性有限的患者，其实际情况比预期要好，要么伤口愈合，要么在16周时伤口面积缩小，这使得他们的伤口护理变得容易得多。应开展前瞻性研究以优化治疗方案，从而确定能否为“实际生活”中的VLU患者群体取得更好的临床疗效。
