Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas.
Wounds. 2021 Jul;33(7):E46-E52.
Complex wounds of the hand often result in soft tissue defects that are not amenable to primary closure, vacuum-assisted closure, or tissue expansion. Injuries presenting with large defects involving multiple levels of tissue must be addressed by using techniques at higher rungs on the reconstructive ladder, such as split-thickness grafting, pedicled flaps, or free flaps. When repairing palmar tissue, these techniques fall short due to their failure to approximate structure and function of specialized skin. More recently, dermal substitutes containing a decellularized extracellular matrix (ECM) have been used in reconstruction of soft tissue defects, acting as a structural scaffold for the regrowth of native cells. Extracellular matrix products have been shown to improve functional and sensory outcomes in areas requiring highly specialized skin. Urinary bladder matrix (UBM), a porcine ECM scaffold, is unique in that it contains an intact epithelial basement membrane that promotes more organized regrowth through layered structure.
This case presents a novel use of this product in resurfacing 80% of a palm after postoperative necrosis following a table saw injury to the right volar palm at the distal crease. The patient had intact sensation and near normal functional outcomes at most recent follow up.
The UBM may be a valuable adjunct to achieve soft tissue coverage in large, complex hand wounds, particularly those involving the palmar surfaces.
手部的复杂创伤常导致软组织缺损，无法进行一期缝合、真空辅助闭合或组织扩张。涉及多个组织层次的大面积缺损的损伤必须采用更高层次的重建阶梯技术来解决，如中厚皮片移植、带蒂皮瓣或游离皮瓣。在修复手掌组织时，由于这些技术无法模拟特殊皮肤的结构和功能，因此存在局限性。最近，含有去细胞细胞外基质 (ECM) 的真皮替代物已被用于重建软组织缺损，作为原生细胞再生的结构支架。研究表明，细胞外基质产品可改善需要高度特殊化皮肤的区域的功能和感觉结果。尿路上皮基质 (UBM) 是一种猪 ECM 支架，其独特之处在于它含有完整的上皮基底膜，通过分层结构促进更有组织的再生。
本病例介绍了该产品在右手掌远侧屈肌腱旁电锯伤术后发生坏死后，对手掌 80%面积进行再覆盖的新用途。患者在最近的随访中具有完整的感觉和接近正常的功能结果。
UBM 可能是实现大手部复杂创伤，特别是涉及手掌表面的软组织覆盖的有价值的辅助手段。
