Kakagia Despoina D, Georgiadis George, Drosos George
Democritus University Hospital, Alexandroupolis, Greece.
Int J Low Extrem Wounds. 2023 Mar;22(1):56-62. doi: 10.1177/1534734621990311. Epub 2021 Jun 1.
The present article aims to present the use of dermal matrices in severe degloving, avulsion, and necrotizing injuries of the leg and foot in 3 patients. Conventional reconstruction would require the use of free flaps, since exposure of vessels, nerves, joints, and tendons rendered the mere resurfacing with skin grafts insufficient, and extensive cutaneous detachment precluded the use of local fasciocutaneous flaps. All injuries underwent thorough and repeated surgical debridements and wash outs, followed by negative pressure wound therapy (NPWT). Once negative tissue cultures were obtained, the extremities were resurfaced with dermal matrix and immediately covered by split thickness skin grafts. NPWT on the grafted area for a week effectively secured the grafts on the recipient area. Complete healing was achieved in all grafted areas within 7 to 12 days. The function of joints and tendons as well as the quality of resurfacing at the weight bearing areas were tested and found satisfactory within a follow-up period of 5 to 15 months. The use of combined NPWT and dermal matrices in carefully selected patients provides a reliable and durable reconstructive option for leg and foot injuries with satisfactory functional outcomes.
本文旨在介绍3例腿部和足部严重脱套伤、撕脱伤和坏死性损伤中真皮基质的应用。传统的重建方法需要使用游离皮瓣，因为血管、神经、关节和肌腱的暴露使得单纯用皮肤移植进行表面覆盖是不够的，而且广泛的皮肤剥离排除了使用局部筋膜皮瓣的可能性。所有损伤均进行了彻底且反复的手术清创和冲洗，随后进行负压伤口治疗（NPWT）。一旦获得阴性组织培养结果，就用真皮基质对肢体进行表面覆盖，并立即用中厚皮片覆盖。在移植区域进行一周的NPWT有效地将移植皮片固定在受区。所有移植区域在7至12天内实现完全愈合。在5至15个月的随访期内，对关节和肌腱的功能以及负重区域的表面覆盖质量进行了测试，结果令人满意。在精心挑选的患者中联合使用NPWT和真皮基质，为腿部和足部损伤提供了一种可靠且持久的重建选择，功能结果令人满意。
