Assistant Professor of Clinical Dermatology, Indiana University, Indiana, US.
J Wound Care. 2023 Jan 1;32(Sup1a):S20-S27. doi: 10.12968/jowc.2023.32.Sup1a.S20.
A wound is hard-to-heal or complex when the defect fails to progress through the normal stages of wound healing in a timely fashion. Hard-to-heal wounds such as diabetic foot or venous leg ulcers can be long-lasting conditions. Alternatively, complex acute wounds that occur from trauma, burns, postoperative, necrosis and some dermatological diseases can also result in hard-to-heal wounds. This article reviews important considerations in the management of complex acute wounds, such as time to wound closure, pain, scarring, patient satisfaction and identification of options that can promote healing of grafts and flaps, while reducing donor-site morbidity. Primary research has demonstrated the inherent benefits of small intestinal submucosa extracellular matrix (SIS-ECM), a naturally occurring porcine matrix that promotes development of dermis-like tissue in both complex acute and hard-to-heal wounds. Presently, the literature provides mostly case studies demonstrating the benefits of SIS-ECM in the management of complex acute wounds. The available case series suggest emerging clinical benefits including rapid time to coverage, avoidance of donor-site complications and development of granulation tissue in locations of low circulation, which improves poor graft sites, potentially reducing dehiscence and providing support for reconstruction flaps and grafts.
当伤口缺陷未能及时进入伤口愈合的正常阶段时，就会出现难以愈合或复杂的情况。糖尿病足或静脉性腿部溃疡等难以愈合的伤口可能是长期存在的情况。另外，由于创伤、烧伤、术后、坏死和一些皮肤病而发生的复杂急性伤口也可能导致难以愈合的伤口。本文综述了复杂急性伤口管理中的一些重要考虑因素，如伤口闭合时间、疼痛、瘢痕形成、患者满意度以及识别可以促进移植物和皮瓣愈合、减少供区发病率的选择。基础研究已经证明了小肠黏膜下层细胞外基质（SIS-ECM）的固有益处，SIS-ECM 是一种天然存在的猪基质，可促进复杂急性和难以愈合伤口中真皮样组织的发展。目前，文献主要提供了病例研究，证明了 SIS-ECM 在复杂急性伤口管理中的益处。现有的病例系列研究表明存在一些临床益处，包括快速覆盖时间、避免供区并发症以及在循环不良部位形成肉芽组织，这改善了较差的移植物部位，可能减少裂开，并为重建皮瓣和移植物提供支持。
