Cazzell Shawn
Limb Preservation Platform, Valley Vascular Surgical Associates, Fresno, CA.
Wounds. 2019 Mar;31(3):68-74. Epub 2019 Jan 31.
Venous leg ulcers (VLUs) are often chronic and difficult to treat, which makes alternative options to conventional care necessary to improve ulcer healing rates. While human acellular dermal matrices (ADMs) have shown promise in treating diabetic foot ulcers, no comparative studies have been published regarding VLU treatment. Decellularized ADMs (D-ADMs) have been used successfully in the treatment of a wide variety of wound repairs and may be effective in treating VLUs.
This study is a multicenter, randomized, controlled, open-label trial designed to evaluate the safety and efficacy of D-ADM compared with conventional wound care management in patients with chronic ulcers of the lower extremity.
Patients were randomly assigned to receive either D-ADM or standard of care (control) in a 2:1 ratio. Treatment began at week 0 and wounds were evaluated on a weekly basis until wound closure was observed or the patient completed 24 weekly follow-up visits.
Eighteen patients were included in the D-ADM arm and 10 patients in the control arm. There was a strong trend of reduction in percent wound area for D-ADM patients with an average reduction of 59.6% at 24 weeks versus 8.1% at 24 weeks for control patients. In addition, healed ulcers in the D-ADM arm remained closed at a substantially higher rate after termination than healed ulcers in the control.
In this report, the authors note the successful increase in healing rates and rate of percent wound closure as compared with conventional care options.
下肢静脉溃疡(VLU)通常病程较长且难以治疗,因此有必要采用替代传统护理的方法来提高溃疡愈合率。虽然人脱细胞真皮基质(ADM)在治疗糖尿病足溃疡方面已显示出前景,但尚未发表关于VLU治疗的比较研究。去细胞ADM(D-ADM)已成功用于多种伤口修复治疗,可能对治疗VLU有效。
本研究是一项多中心、随机、对照、开放标签试验,旨在评估D-ADM与传统伤口护理管理相比,在下肢慢性溃疡患者中的安全性和有效性。
患者按2:1的比例随机分配接受D-ADM或标准护理(对照)。治疗从第0周开始,每周对伤口进行评估,直至观察到伤口闭合或患者完成24次每周随访。
D-ADM组纳入18例患者,对照组纳入10例患者。D-ADM组患者伤口面积百分比有明显下降趋势,24周时平均下降59.6%,而对照组患者24周时为8.1%。此外,D-ADM组愈合的溃疡在治疗结束后保持闭合的比例显著高于对照组愈合的溃疡。
在本报告中,作者指出与传统护理方法相比,愈合率和伤口闭合百分比成功率有所提高。