Burgueno-Vega Diana, Shahani Dilip, Conlan Walter, Blakely Melodie
Lakeland Regional Health, Lakeland, Florida.
Orlando Regional Medical Center, Orlando, Florida.
Eplasty. 2023 Jun 14;23:e34. eCollection 2023.
Late-effect radiation-induced wounds represent a particularly difficult category of wounds to manage and treat. Fibrosis, impaired cellular activity, ischemia, and wound chronicity all work to impair healing, and this becomes more pronounced when defects are large or when avascular structures such as bone are exposed. Effective treatment options for this type of wound are limited. Thorough excision of irradiated tissue followed by distal pedicled or free flap closure is the most successful; however, this often requires multiple-stage surgeries and prolonged hospitalization and is associated with significant donor site morbidity. This is complicated further when wounds are large or in difficult locations, when surgery is not appropriate, or when there is limited access to surgeons with the appropriate experience/skill to perform such procedures.
This case series describes the use of an autologous heterogenous skin construct (AHSC) made from a small full-thickness sample of the patient's healthy skin. Three patients with intractable late-effect radiation wounds were treated with AHSC. Case 1 describes an abdominal wound with tunneling of 7.5 cm to the pubic symphysis, which had been treated for known osteomyelitis, and a shallower full-thickness groin wound. Case 2 describes a right scapular wound with exposed bone, which had failed flap closure. Case 3 describes a right thigh wound in a patient who had been treated for sarcoma with extensive radiation therapy. This eventually resulted in an above-the-knee amputation, which failed to heal, and full exposure of the distal end of the resected femur. All wounds had been present for greater than 10 months.
Mean percent volume reduction was 83% (±2.7) at 3 weeks and 92.9% (±4.7) at 4 weeks. The tunneled abdominal wound decreased in depth from 7.5 cm to 1.2 cm in 3 weeks. Complete closure was achieved at 11 weeks for the abdominal and groin wounds (patient 1) and at 16 weeks for the thigh wound (patient 3). The scapular wound volume of patient 2 had decreased by 91.8% at week 4 but was not fully restored until week 21. Mean time to closure was 16.1 (±4.7) weeks.
AHSC was effective in covering exposed bone, improving wound bed vascularity, filling in significant wound depth, and achieving complete wound closure with one application in patients with intractable late-effect radiation wounds.
放射性迟发性伤口是一类特别难以处理和治疗的伤口。纤维化、细胞活性受损、局部缺血以及伤口慢性化都会影响伤口愈合，当伤口较大或暴露骨骼等无血管结构时，这种情况会更加明显。这类伤口的有效治疗选择有限。彻底切除受照射组织，然后采用带蒂远端皮瓣或游离皮瓣闭合是最成功的方法；然而，这通常需要多阶段手术和长时间住院，并且会导致供区出现明显的并发症。当伤口较大或位置特殊、手术不适用，或者缺乏有适当经验/技能进行此类手术的外科医生时，情况会更加复杂。
本病例系列描述了一种由患者健康皮肤的小全层样本制成的自体异种皮肤构建物（AHSC）的应用。三名患有顽固性放射性迟发性伤口的患者接受了AHSC治疗。病例1描述了一个腹部伤口，其向耻骨联合方向有7.5厘米的窦道，该伤口曾因已知的骨髓炎接受治疗，还有一个较浅的全层腹股沟伤口。病例2描述了一个右肩胛伤口，有骨质暴露，皮瓣闭合失败。病例3描述了一名接受广泛放射治疗的肉瘤患者的右大腿伤口。这最终导致了膝上截肢，截肢伤口未能愈合，切除的股骨远端完全暴露。所有伤口均已存在超过10个月。
3周时平均体积减少百分比为83%（±2.7），4周时为92.9%（±4.7）。腹部窦道伤口在3周内深度从7.5厘米降至1.2厘米。腹部和腹股沟伤口（患者1）在11周时完全闭合，大腿伤口（患者3）在16周时完全闭合。患者2的肩胛伤口体积在第4周时减少了91.8%，但直到第21周才完全恢复。平均闭合时间为16.1（±4.7）周。
对于患有顽固性放射性迟发性伤口的患者，AHSC可有效覆盖暴露的骨骼，改善伤口床的血管化，填充较大的伤口深度，并一次应用即可实现伤口完全闭合。
