Department of Orthopaedic Surgery, RWJ Barnabas Health - Jersey City Medical Center, 355 Grand Street, Jersey City 07302, NJ, USA.
Department of Orthopaedic Surgery, RWJ Barnabas Health - Jersey City Medical Center, 355 Grand Street, Jersey City 07302, NJ, USA.
Injury. 2020 Jun;51(6):1266-1270. doi: 10.1016/j.injury.2020.03.008. Epub 2020 Mar 4.
Multiple small relaxing skin incisions oriented parallel to the longitudinal axis (so-called "pie-crusting") near traumatic lacerations or surgical incisions in edematous tissue beds have been utilized to achieve primary closure when edema or skin loss would otherwise have made this difficult. Our study hopes to demonstrate (1) biomechanical evidence that pie-crusting decreases wound closure tension and (2) provide a case series with data showing clinical results.
This study is a biomechanical cadaveric study and retrospective small series cohort using 16 porcine limbs and 7 patients with 8 wounds in which pie-crusting was performed. An elliptical incision was made on the porcine limbs and the wound closure tension was measured with a hydraulic test machine before and after pie-crusting. The retrospective patient cohort had pie-crusting performed on traumatic wounds that were difficult to primarily close. The patient cohort was assessed by retrospective chart review examining wound dimensions before and after pie-crusting, and wound healing at final follow-up.
The biomechanical data showed that pie-crusting the wound with both a single and double row of incisions significantly decreased the closing tension. A single row decreased wound tension by an average of 34%. Using an average of 3.5 parallel layers of pie-crusting at the time of definitive closure all wounds in the patient cohort closed and healed well with no complications at average follow-up (average 18 months).
Pie-crusting may allow for easier wound closure and decrease the need for skin-grafting in edematous extremity wounds, with minimal patient morbidity.
在创伤性撕裂伤或肿胀组织床的手术切口附近，多条与纵轴平行的小松弛皮肤切口（所谓的“馅饼皮状”）已被用于实现原发性闭合，否则水肿或皮肤缺失会使这变得困难。我们的研究希望证明：（1）生物力学证据表明馅饼皮状可以降低伤口闭合张力；（2）提供一个病例系列，其中数据显示临床结果。
本研究是一项生物力学尸体研究和回顾性小系列队列研究，使用了 16 个猪肢体和 7 名患者的 8 个伤口，其中进行了馅饼皮状。在猪肢体上做了一个椭圆形切口，并用液压试验机测量馅饼皮状前后的伤口闭合张力。回顾性患者队列中有创伤性伤口难以直接闭合，进行了馅饼皮状。通过回顾性图表审查评估伤口尺寸，在馅饼皮状前后，以及最终随访时的伤口愈合情况，对患者队列进行评估。
生物力学数据表明，单排和双排切口的馅饼皮状显著降低了闭合张力。单行平均减少伤口张力 34%。在确定性闭合时使用平均 3.5 层平行的馅饼皮状，患者队列中的所有伤口均闭合且愈合良好，平均随访（平均 18 个月）无并发症。
馅饼皮状可能允许更容易地闭合伤口，并减少肿胀肢体伤口对皮肤移植的需求，患者发病率最低。
