Desvigne Micheal N, Bauer Krista, Holifield Kurt, Day Kari, Gilmore Denise, Wardman Ashley L
Desvigne Plastic Surgery, Scottsdale, AZ, United States.
Abrazo Arrowhead Hospital, Glendale, AZ, United States.
Front Surg. 2021 Jan 26;7:559450. doi: 10.3389/fsurg.2020.559450. eCollection 2020.
Chronic soft tissue defects are notoriously difficult to heal. Surgical reconstruction of chronic defects using tissue flaps is a routine approach for closure of challenging chronic defects. Due to the poor tissue quality of chronic defects and associated inflammation, infection and impaired blood supply the success of flap closure is marred by reported complication rates of 25-58%. Extracellular matrix (ECM)-based graft materials are commonly used for resolving chronic wounds and in plastic and reconstructive procedures to create a scaffold for tissue regeneration. We hypothesized combination use of ECM grafts with tissue flaps in a single-stage surgical procedure would reduce complications and improve outcomes in the closure of chronic soft tissue defects. We report a case series ( = 9) of chronic soft tissue defect reconstruction using this modified procedure of ECM graft augmented flap closure. Defects included pressure injuries and surgical dehiscence and ranged in wound age from 5 months to 7 years. Successful uncomplicated healing was achieved in six defects. Post-operative complications (dehiscence) occurred in two defects, however, these healed secondary intention without additional surgical intervention. All healed defects exhibited acceptable cosmesis and "normal" function, with 100% patient satisfaction. Augmentation of tissue flaps with ECM graft materials in this modified single-stage procedure may improve outcomes and minimize typical complications encountered in flap closure of chronic defects attributed to inflammation, infection, hypoperfusion, and dead space.
慢性软组织缺损 notoriously 难以愈合。使用组织瓣对慢性缺损进行手术重建是闭合具有挑战性的慢性缺损的常规方法。由于慢性缺损的组织质量差以及相关的炎症、感染和血液供应受损，皮瓣闭合的成功率受到影响，报道的并发症发生率为25% - 58%。基于细胞外基质（ECM）的移植材料常用于治疗慢性伤口以及在整形和重建手术中为组织再生创建支架。我们假设在单阶段手术中联合使用ECM移植物和组织瓣将减少并发症并改善慢性软组织缺损闭合的效果。我们报告了一组病例（n = 9），采用这种改良的ECM移植物增强皮瓣闭合手术进行慢性软组织缺损重建。缺损包括压疮和手术切口裂开，伤口年龄从5个月到7年不等。六个缺损实现了成功且无并发症的愈合。术后有两个缺损出现了并发症（裂开），然而，这些缺损通过二期愈合，无需额外的手术干预。所有愈合的缺损都表现出可接受的美容效果和“正常”功能，患者满意度为100%。在这种改良的单阶段手术中用ECM移植材料增强组织瓣可能会改善效果，并将慢性缺损皮瓣闭合中因炎症、感染、灌注不足和死腔导致的典型并发症降至最低。
