Horwich Peter, Sivarajah Shanmugappiriya, Neskey David, Hornig Joshua
Head and Neck Specialists, HCA South Atlantic, HCA Healthcare, Charleston, SC, USA.
Sarah Cannon Cancer Institute, Head and Neck Specialists, Charleston, SC, USA.
Case Rep Oncol. 2024 Jun 7;17(1):622-629. doi: 10.1159/000539200. eCollection 2024 Jan-Dec.
Patients with head and neck cancer often necessitate complex reconstructions, considering both functional and esthetic concerns. Reconstructions are further complicated by previous radiation therapy and patient co-morbidities, which impair wound healing. A recently introduced synthetic hybrid-scale fiber matrix has been shown to provide durable wound coverage and promote tissue healing as an alternative to traditional biologic allogenic and xenogenic skin substitutes.
Thirteen patients were treated at a single academic hospital between December 1, 2021, and May 1, 2023 with the synthetic matrix in head and neck reconstructions. Reconstructions included exposed muscle, scalp wounds, intra-oral defects, and radial forearm free flap donor sites. Wound sizes ranged from 2 × 2 cm to 18 × 10 cm. Serial photographs were taken to evaluate wound healing at 1, 4, 8, 12, and 16 weeks timepoints after application. Outcomes measured at each timepoint included wound size, presence of granulation tissue, and extent of epithelialization. No hematomas or wound complications were encountered. Complete wound healing was noted between 6 and 12 weeks, dependent on wound size. The synthetic matrix significantly promoted wound healing via early granulation tissue formation and epithelialization, or mucosalization, in all head and neck applications. Scar formation and contracture were acceptable in all cases.
The use of synthetic hybrid-scale fiber matrix promotes wound healing and avoids patient morbidity associated with traditional allogenic and biogenic treatments, such as split-thickness skin grafts. This synthetic matrix has been demonstrated to be a valuable asset in the head and neck reconstructive armamentarium.
考虑到功能和美观问题，头颈癌患者常常需要进行复杂的重建手术。先前的放射治疗和患者的合并症会使伤口愈合受损，这进一步增加了重建手术的复杂性。最近引入的一种合成混合尺度纤维基质已被证明可提供持久的伤口覆盖，并促进组织愈合，作为传统生物同种异体和异种皮肤替代品的一种替代方案。
在2021年12月1日至2023年5月1日期间，一家学术医院对13例患者使用合成基质进行头颈重建手术。重建手术包括暴露的肌肉、头皮伤口、口腔内缺损以及桡侧前臂游离皮瓣供区。伤口大小从2×2厘米到18×10厘米不等。在应用后1、4、8、12和16周的时间点拍摄系列照片，以评估伤口愈合情况。每个时间点测量的结果包括伤口大小、肉芽组织的存在情况以及上皮化程度。未出现血肿或伤口并发症。根据伤口大小，在6至12周内实现了完全伤口愈合。在所有头颈应用中，合成基质通过早期肉芽组织形成和上皮化或黏膜化显著促进了伤口愈合。在所有病例中，瘢痕形成和挛缩情况均可接受。
使用合成混合尺度纤维基质可促进伤口愈合，并避免与传统同种异体和生物治疗（如中厚皮片移植）相关的患者发病率。这种合成基质已被证明是头颈重建手段中的一项宝贵资产。
