Division of Plastic Surgery, Cooper University Hospital, Camden, New Jersey.
Department of Plastic Surgery, University of Tennessee Health Science Center, Memphis.
J Burn Care Res. 2020 Jul 3;41(4):828-834. doi: 10.1093/jbcr/iraa044.
Lower extremity wounds with exposed bone and tendon often need coverage to allow the underlying tissue to regenerate prior to skin graft. The surgeon is limited in his or her choices to augment tissue regeneration in these types of complicated cases; for instance, autologous skin should not be placed on exposed bone or tendon and is at risk for contracture when placed over the joints. Therefore, novel technologies are necessary to provide a scaffolding for tissue to regenerate and allow for a successful graft. One such technology is an esterified hyaluronic acid matrix (eHAM), which can provide a proper scaffold for endothelial cell migration and aid in angiogenesis. The eHAM is made of two layers: a layer of hyaluronic acid covered with a silicone layer. In this retrospective chart review, we describe our usage of eHAM to provide scaffolding for tissue regeneration prior to grafting in 15 cases of complicated lower extremity wounds with exposed bone and tendon. The average patient age was 45.8 years, and all patients had multiple medical comorbidities, such as poorly controlled diabetes mellitus, hypertension, and nicotine addiction. Patient wound types were diverse, including traumatic wounds, chronic diabetic foot ulcers, and thermal or electric burns. Thirteen of the 15 cases were treated successfully with eHAM. In these cases, definitive coverage with split-thickness skin grafting was effective and limb salvage was successful. In the 13 successful cases, the mean time to split-thickness skin graft was 22.9 ± 7.0 days. All patients continue to do well at follow-up (ranging from 6 to 48 weeks), with minimal complications reported. Given the success rate with eHAM in this challenging population, we conclude that eHAM can be a treatment option for similar cases.
下肢有骨和肌腱外露的伤口通常需要覆盖物，以便在植皮前让下面的组织再生。在这些复杂病例中，外科医生在增强组织再生方面的选择有限；例如，自体皮肤不应放置在暴露的骨或肌腱上，并且当放置在关节上时存在挛缩的风险。因此，需要新的技术为组织再生提供支架，并确保移植的成功。一种这样的技术是酯化透明质酸基质（eHAM），它可以为内皮细胞迁移提供适当的支架，并有助于血管生成。eHAM 由两层组成：一层透明质酸覆盖着一层硅酮层。在这项回顾性图表审查中，我们描述了我们在 15 例下肢有骨和肌腱外露的复杂伤口中使用 eHAM 在植皮前提供组织再生支架的情况。平均患者年龄为 45.8 岁，所有患者都有多种合并症，如未控制的糖尿病、高血压和尼古丁成瘾。患者的伤口类型多种多样，包括创伤性伤口、慢性糖尿病足溃疡和热或电烧伤。在 15 例中有 13 例成功接受了 eHAM 治疗。在这些病例中，使用中厚皮片移植进行确定性覆盖是有效的，肢体得以保留。在 13 例成功病例中，中厚皮片移植的平均时间为 22.9±7.0 天。所有患者在随访时情况良好（6 至 48 周不等），报告的并发症很少。鉴于 eHAM 在这一具有挑战性的人群中的成功率，我们得出结论，eHAM 可以成为类似病例的一种治疗选择。
