Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Wounds. 2024 Jul;36(7):234-244. doi: 10.25270/wnds/23107.
Venous leg ulcers (VLUs) are the most common type of chronic wound in the lower extremity and are often associated with redness, swelling, and pain at the site of the wound. The primary focus of VLU treatment is the promotion of wound healing through compression therapy, wound debridement, and elevation of the affected limb. Acellular matrices have gained traction as a potential adjunct to wound healing in diabetic foot ulcers. However, the clinical effect of acellular products in the setting of VLUs has not been well reported.
To review the published evidence on the use of acellular products in the management of VLUs.
PubMed, Embase, Cochrane, and Google Scholar databases were initially searched on March 2, 2023, for literature on VLU and acellular dermal matrix. Later, the search was broadened to include any and all acellular matrices, and a secondary search of the same databases was conducted on February 20, 2024. Articles obtained through collateral methods were also included.
A total of 27 articles were identified for review. All studies were human studies. Four articles had level I evidence and 7 articles had level II evidence, while the remaining articles had level III or IV evidence. Studies included both large and small wound sizes ranging from 0.5 cm² to 100 cm2. Product application occurred once to twice weekly for 4 weeks to up to 36 months. Overall, regardless of ulcer size, the majority of studies reported favorable wound healing outcomes with the use of a variety of acellular skin coverage products with few complications. Some studies also reported pain reduction with the use of acellular skin substitutes in a small cohort of patients.
Acellular products appear to have the potential to support healing in VLUs. However, more large-scale randomized controlled trials that provide level I evidence are needed.
静脉性腿部溃疡（VLUs）是下肢最常见的慢性伤口类型，常伴有伤口部位的红肿、肿胀和疼痛。VLU 治疗的主要重点是通过压迫治疗、伤口清创和抬高受影响的肢体来促进伤口愈合。去细胞基质作为糖尿病足溃疡伤口愈合的辅助治疗方法已得到广泛关注。然而，去细胞产品在 VLUs 中的临床效果尚未得到很好的报道。
综述已发表的关于去细胞产品在 VLUs 管理中的应用证据。
2023 年 3 月 2 日，我们最初在 PubMed、Embase、Cochrane 和 Google Scholar 数据库中搜索 VLUs 和去细胞真皮基质相关文献。后来，我们将搜索范围扩大到包括所有去细胞基质，并于 2024 年 2 月 20 日对同一数据库进行了二次搜索。通过其他途径获得的文章也包括在内。
共确定了 27 篇文章进行综述。所有研究均为人体研究。其中 4 篇文章为 I 级证据，7 篇文章为 II 级证据，其余文章为 III 级或 IV 级证据。研究纳入的伤口大小从 0.5cm²到 100cm²不等，既有小伤口也有大伤口。产品应用频率为每周 1 到 2 次，持续 4 周至 36 个月。总体而言，无论溃疡大小如何，大多数研究报告使用各种去细胞皮肤覆盖产品均可获得良好的伤口愈合效果，且并发症较少。一些研究还报告称，在一小部分患者中，使用去细胞皮肤替代物可减轻疼痛。
去细胞产品似乎有潜力支持 VLUs 的愈合。然而，还需要更多提供 I 级证据的大规模随机对照试验。
