Lawlor John, Bosque Brandon A, Frampton Christopher, Young D Adam, Martyka Patrick
From the Department of Surgery, Associates in Medicine and Surgery, Fort Myers, FL.
Department of Medical Affairs, Aroa Biosurgery Limited, Auckland, NZ.
Plast Reconstr Surg Glob Open. 2024 Dec 20;12(12):e6406. doi: 10.1097/GOX.0000000000006406. eCollection 2024 Dec.
Complex and chronic lower extremity defects present a surgical challenge and can progress to eventual amputation if closure is not achieved. In addition to morbidity and mortality, these defects have a significant impact on patient quality of life and represent a substantial cost burden to the healthcare system. Ovine forestomach matrix (OFM) grafts are an advanced tissue scaffold option to supplement the surgical reconstruction ladder and may augment limb preservation in cases of complex lower extremity defects.
A prospective observational study enrolled 130 complex lower extremity reconstructions that received OFM as part of surgical management. Granulation tissue formation, defect closure, and postoperative complications were assessed up to 1 year postoperatively to evaluate the outcome of OFM grafts for limb salvage via surgical reconstruction.
Participant demographics and defect characteristics were reflective of a real-world inpatient population with complex and chronic defects. Despite complexity of the defects, no postoperative infections or major amputations were reported. The median time to complete granulation tissue coverage and fill was 30.0 days (95% confidence interval, 26.9-33.1) and the median time to complete defect closure was 127.0 days (95% confidence interval, 110.5-143.5). At 180 days, a 62% incidence of healing was achieved with a median product application of 1.0 (interquartile range, 1.0-1.0).
OFM-based grafts supported successful coverage of lower extremity defects in a real-world cohort with known risk-factors for amputation. Achieving successful closure with minimal complications, and often in a single application, suggests utility of OFM as a cost-effective adjunct in lower extremity reconstruction.
复杂的慢性下肢缺损带来了手术挑战，如果无法实现伤口闭合，可能会进展为最终截肢。除了发病率和死亡率外，这些缺损对患者生活质量有重大影响，并且给医疗系统带来沉重的成本负担。绵羊前胃基质（OFM）移植物是一种先进的组织支架选择，可补充手术重建方法，并且在复杂下肢缺损的病例中可能增加肢体保留的几率。
一项前瞻性观察性研究纳入了130例接受OFM作为手术治疗一部分的复杂下肢重建手术。术后长达1年评估肉芽组织形成、缺损闭合情况及术后并发症，以评估通过手术重建使用OFM移植物挽救肢体的效果。
参与者的人口统计学特征和缺损特点反映了患有复杂慢性缺损的真实世界住院患者群体。尽管缺损情况复杂，但未报告术后感染或大截肢病例。完成肉芽组织覆盖和填充的中位时间为30.0天（95%置信区间，26.9 - 33.1），完成缺损闭合的中位时间为127.0天（95%置信区间，110.5 - 143.5）。在180天时，愈合发生率为62%，中位产品应用次数为1.0（四分位间距，1.0 - 1.0）。
在一个已知有截肢风险因素的真实世界队列中，基于OFM的移植物成功支持了下肢缺损的覆盖。以最少的并发症实现成功闭合，且通常单次应用即可成功，这表明OFM作为下肢重建中一种具有成本效益的辅助手段具有实用性。
