Department of Surgery, Central Michigan School of Medicine, St. Joseph Hospital, 200 Hemlock Rd, Tawas City, Michigan 48763, US.
Department of Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, Louisiana 70112, US.
J Wound Care. 2020 Dec 2;29(12):742-749. doi: 10.12968/jowc.2020.29.12.742.
Soft tissue defects, especially those involving exposed vital structures, present a reconstructive challenge because poor vascularity of such defects typically makes immediate skin grafting unviable. Where flap procedures are inappropriate or not possible, dermal matrices represent an alternative reconstructive option for defects with denuded vital structures. With dermal matrices becoming increasingly available and technologically advanced, we evaluated an ovine-derived extracellular matrix graft in the reconstruction of complex soft tissue defects involving exposed vital structures.
Six cases of soft tissue defects exhibiting denuded vital structures underwent reconstruction using an ovine forestomach matrix graft as a dermal matrix. Grafts were fixed directly into defects for immediate coverage and subsequently temporised defects via granulation tissue formation for later skin graft or secondary closure. Defect granulation and epithelialisation were monitored until closure and the final aesthetic and functional outcomes were evaluated.
Complete healing was achieved in all cases, with defect granulation becoming observable within one to two weeks and complete granulation occurring within one to six weeks. Granulation tissue resulting from the graft was suitable for skin grafting, with 100% take of skin grafts after one week and complete re-epithelialisation in two to three weeks in the four cases that received a skin graft. Good cosmetic, functional and patient satisfaction outcomes were achieved in all cases.
The present series demonstrates our initial use of an extracellular matrix-based dermal matrix in reconstructing defects with exposed vital structures. While such dermal matrices do not supersede or replace flap procedures, they represent an alternative option on the reconstructive ladder in cases where flap procedures are not appropriate or possible.
软组织缺损，特别是那些涉及暴露的重要结构的缺损，具有一定的重建挑战性，因为这些缺损的血管化较差，通常使即刻皮片移植不可行。在皮瓣手术不适用或不可能的情况下，真皮基质是裸露重要结构的缺损的另一种重建选择。随着真皮基质的应用越来越广泛和技术的不断进步，我们评估了一种羊源细胞外基质移植物在重建涉及暴露重要结构的复杂软组织缺损中的应用。
6 例存在裸露重要结构的软组织缺损患者，采用羊前胃基质移植物作为真皮基质进行重建。移植物直接固定于缺损处以即刻覆盖，随后通过肉芽组织形成临时覆盖缺损，以便后期皮片移植或二期缝合。监测缺损的肉芽形成和上皮化情况，直到闭合，并评估最终的美学和功能结果。
所有病例均实现完全愈合，缺损的肉芽形成在 1 至 2 周内可见，完全肉芽形成在 1 至 6 周内完成。移植物产生的肉芽组织适合进行皮片移植，在接受皮片移植的 4 例中，皮片移植后 1 周内 100%成活，2 至 3 周内完全上皮化。所有病例均获得良好的美容、功能和患者满意度结果。
本系列初步展示了我们使用基于细胞外基质的真皮基质重建暴露重要结构的缺损的应用。虽然这些真皮基质不能替代或取代皮瓣手术，但在皮瓣手术不适用或不可能的情况下，它们是重建阶梯中的另一种选择。
