Division of Orthopedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock St, MC 0188, Denver, CO, 80204, USA.
Eur J Orthop Surg Traumatol. 2024 May;34(4):1971-1977. doi: 10.1007/s00590-024-03888-9. Epub 2024 Mar 15.
To compare dermal regenerative template (DRT), with and without split-thickness skin-grafting (STSG), and urinary bladder matrix (UBM) for coverage of lower extremity wounds.
A retrospective review of 56 lower extremity wounds treated with either DRT and STSG (DRT-S) (n = 18), DRT only (n = 17), or UBM only (n = 21). Patient characteristics, comorbidities, American Society of Anesthesiology (ASA) classification, injury characteristics, wound characteristics, use of negative pressure wound therapy, surgical details, postoperative care, and failure of primary wound coverage procedure were documented.
The DRT group, compared to the DRT-S group, was older [median difference (MD) 17.4 years, 95% confidence interval (CI) 9.1-25.7; p = 0.0008], more diabetic (proportional difference (PD) 54.2%, CI 21.2-76.1%; p = 0.002), had smaller wounds (MD - 91.0 cm, CI - 125.0 to - 38.0; p = 0.0008), more infected wounds (PD 49.0%, CI 16.1-71.7%; p = 0.009), a shorter length of stay after coverage (MD - 5.0 days, CI - 29.0 to - 1.0; p = 0.005), and no difference in primary wound coverage failure (41.2% vs. 55.6%; p = 0.50). The UBM group, compared to the DRT group, was younger (MD - 6.8 years; CI - 13.5 to - 0.1; p = 0.04), had fewer patients with an ASA > 2 (PD - 35.0%, CI - 55.2% to - 7.0%; p = 0.02), diabetes (PD - 49.2%, CI - 72.4% to - 17.6%; p = 0.003), and had no difference in primary wound coverage failure (36.4% vs. 41.2%; p = 1.0). Failure of primary wound coverage was found to only be associated with larger wound surface areas (MD 22.0 cm, CI 4.0-90.0; p = 0.01).
DRT and UBM coverage had similar rates of primary wound coverage failure for lower extremity wounds.
Diagnostic, Level III.
比较真皮再生模板（DRT）联合和不联合刃厚皮片游离移植（DRT-S）以及膀胱黏膜移植物（UBM）治疗下肢创面。
回顾性分析了 56 例下肢创面，分别采用 DRT-S（n=18）、DRT 单独治疗（n=17）或 UBM 单独治疗（n=21）。记录患者特征、合并症、美国麻醉医师协会（ASA）分级、损伤特征、创面特征、负压伤口治疗的使用、手术细节、术后护理以及初次创面覆盖失败的情况。
与 DRT-S 组相比，DRT 组患者年龄更大[中位数差值（MD）17.4 岁，95%置信区间（CI）9.1-25.7；p=0.0008]，糖尿病患者比例更高（比例差值（PD）54.2%，CI 21.2-76.1%；p=0.002），创面更小（MD -91.0cm，CI -125.0 至 -38.0；p=0.0008），感染创面更多（PD 49.0%，CI 16.1-71.7%；p=0.009），覆盖后住院时间更短（MD -5.0 天，CI -29.0 至 -1.0；p=0.005），初次创面覆盖失败率无差异（41.2% vs. 55.6%；p=0.50）。与 DRT 组相比，UBM 组患者年龄更小（MD -6.8 岁；CI -13.5 至 -0.1；p=0.04），ASA 分级>2 的患者比例更低（PD -35.0%，CI -55.2%至 -7.0%；p=0.02），糖尿病患者比例更低（PD -49.2%，CI -72.4%至 -17.6%；p=0.003），初次创面覆盖失败率无差异（36.4% vs. 41.2%；p=1.0）。初次创面覆盖失败仅与更大的创面面积相关（MD 22.0cm，CI 4.0-90.0；p=0.01）。
DRT 和 UBM 覆盖治疗下肢创面的初次创面覆盖失败率相似。
诊断，III 级。
