Mercy Hospital South, St. Louis, Missouri, US.
J Wound Care. 2024 Sep 1;33(Sup9):S5-S16. doi: 10.12968/jowc.2024.0176.
While most xenograft wound matrices are flat sheets not designed for deep or tunnelling wounds, three-dimensional acellular collagen matrices (3D-ACM) can fill deep wound beds and enable full wound wall apposition. This case series examines the use of 3D-ACM in treating diabetic foot ulcers (DFUs) that are deep, tunnelling, undermining, or irregularly shaped. We report outcomes of cases where 3D-ACM was applied to deep or tunnelling DFUs present for at least four weeks.
In this retrospective case series, 3D-ACM was applied, healing was monitored and measurements were collected. Additional 3D-ACM was applied as needed.
In total, 11 patients with 13 wounds were treated. Improved wound appearance and reduced size were observed at most follow-ups. Mean initial wound depth was 1.6cm, and several wounds showed significant depth reductions shortly after therapy initiation. In total, 62% of wounds (8/13) reached 50% closure by four weeks. Additionally, 54% (7/13) were fully closed by 12 weeks. The remaining 46% (6/13) took between 12-22.3 weeks to heal. Overall mean therapy time was 13.1 weeks (range: 2.0-22.3 weeks). Deeper wounds generally took longer to close.
The findings of this case series showed that 3D-ACM could offer a protective microenvironment for wound management for deep or tunnelling DFUs. While some took >12 weeks to close, this may be attributable to large initial depths and volumes, rather than a failure to respond to the treatment modality. Other wounds that require a conforming 3D matrix, enabling full wound wall apposition, may benefit from 3D-ACM. Further investigations would be beneficial to understand the capabilities of this treatment modality.
虽然大多数异种移植物伤口基质为平板状，不适合用于深部或隧道伤口，但三维去细胞胶原基质（3D-ACM）可填充深部伤口床并实现全壁贴合。本病例系列研究了 3D-ACM 在治疗深度、隧道状、潜行或形状不规则的糖尿病足溃疡（DFU）中的应用。我们报告了在至少四周存在深部或隧道状 DFU 时应用 3D-ACM 的病例结果。
在这项回顾性病例系列研究中，应用 3D-ACM，监测愈合情况并收集测量数据。根据需要额外应用 3D-ACM。
共有 11 例患者的 13 处伤口接受了治疗。在大多数随访中，观察到伤口外观改善且面积缩小。初始伤口深度平均为 1.6cm，一些伤口在治疗开始后不久深度明显减小。总共，62%（8/13）的伤口在四周时达到 50%闭合。此外，54%（7/13）在 12 周时完全闭合。其余 46%（6/13）的伤口需要 12-22.3 周愈合。总体平均治疗时间为 13.1 周（范围：2.0-22.3 周）。较深的伤口通常需要更长时间才能闭合。
本病例系列的结果表明，3D-ACM 可为深部或隧道状 DFU 的伤口管理提供保护性微环境。虽然有些伤口需要>12 周才能闭合，但这可能归因于初始深度和体积较大，而不是对治疗方式无反应。其他需要贴合的三维基质以实现全壁贴合的伤口可能受益于 3D-ACM。进一步的研究将有助于了解这种治疗方式的能力。
