Chan Peter Y W, Michel Chris, Colon Anthony F, Clune James, Shah Ajul
From the Institute for Advanced Reconstruction.
Department of Orthopedic Surgery, Monmouth Medical Center.
Plast Reconstr Surg. 2023 Apr 1;151(4):673e-678e. doi: 10.1097/PRS.0000000000010015. Epub 2022 Dec 9.
The goal of wound reconstruction is the approximation of soft tissue and re-establishment of an acceptable appearance with minimal risk of complications. For large wound closure in the extremities, skin graft and flap reconstruction are common treatments but are associated with a variety of complications. Comparatively, tissue expansion can provide the opportunity to reconstruct large wounds with native, durable, and sensate tissue without significant donor site morbidity. External tissue expansion is less invasive and avoids complications associated with internal expansion. The authors treated 11 patients with varying extremity wound types and sizes with an external tissue expansion device. Patient age ranged from 18 to 68 years with an average age of 43.7 years (SD, ± 13.1 years). Average wound surface area was approximately 235 cm 2 (SD, ± 135.3 cm 2 ). Devices were affixed and left for 7 to 11 days before closure of the wounds. Outcomes were assessed at 2 to 36 weeks postoperative follow-up. All wounds were fully closed after treatment without need for secondary reconstructive procedures. No patient experienced major complications. All patients demonstrated intact sensation within the area of reconstruction equivalent to surrounding tissues. External tissue expansion, an excellent treatment option in extremity reconstruction, is efficacious and associated with lower complication rates compared with internal tissue expansion, skin grafts, and flap reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
伤口重建的目标是使软组织接近正常状态，并在并发症风险最小的情况下重建出可接受的外观。对于四肢的大面积伤口闭合，皮肤移植和皮瓣重建是常见的治疗方法，但会伴有多种并发症。相比之下，组织扩张能够利用自身的、耐用的、有感觉功能的组织来重建大面积伤口，且供区并发症较少。外部组织扩张的侵入性较小，可避免与内部扩张相关的并发症。作者使用外部组织扩张装置治疗了11例四肢伤口类型和大小各异的患者。患者年龄在18岁至68岁之间，平均年龄为43.7岁（标准差，±13.1岁）。平均伤口表面积约为235平方厘米（标准差，±135.3平方厘米）。在伤口闭合前，将装置固定并放置7至11天。在术后2至36周的随访中评估治疗效果。所有伤口在治疗后均完全闭合，无需进行二次重建手术。没有患者出现严重并发症。所有患者在重建区域内的感觉均保持完整，与周围组织相当。外部组织扩张是四肢重建中的一种优秀治疗选择，与内部组织扩张、皮肤移植和皮瓣重建相比，它有效且并发症发生率更低。
临床问题/证据级别：治疗性，IV级。
