Ger R, Evans J T, Oddsen R
Department of Surgery, Nassau County Medical Center, East Meadow 11554, USA.
Am J Surg. 1996 Mar;171(3):331-4. doi: 10.1016/S0002-9610(97)89636-5.
Wounds that heal slowly may pass through a subacute phase and proceed to reach a chronic situation. The latter may heal slowly, if at all. These wounds often heal by secondary intention with a single layer of epithelium that has a tendency to break down. Methods that expedite healing by full-thickness skin usually involve operative procedures. A nonoperative method of achieving coverage of tardy wounds with full-thickness skin, partial or complete depending on the wound, would be valuable.
A device has been designed that approximates the wound margins by applying constant low-grade tension over a period of days or weeks. One or more devices have been applied to the wounds of 25 patients to date.
Healing has been obtained in those patients (20) where the devices were used optimally. In 5 patients, optimal use was not possible, mostly for socioeconomic reasons; the latter included noncompliance, insurance problems, economic difficulties, and personal considerations. In these 5 cases, healing was obtained in the 3 that were available for follow-up, full-thickness skin coverage being estimated by grid photography to be in the 80% to 90% range. One patient was lost to follow-up after the wound was 95% covered by full-thickness skin. One patient whose wound reduced in size declined further treatment after 12 days of treatment.
It appears that when constant-tension, low-grade force is applied to subacute and chronic wounds, healing is accelerated and, depending on the wound, a considerable number of ulcers can be closed by full-thickness skin.
愈合缓慢的伤口可能会经历亚急性期，进而发展为慢性伤口。后者愈合缓慢，甚至可能根本无法愈合。这些伤口通常通过二期愈合，形成单层上皮，且该上皮有分解的倾向。通过全层皮肤加速愈合的方法通常涉及手术操作。一种非手术方法，即根据伤口情况部分或完全用全层皮肤覆盖迁延不愈的伤口，将具有重要价值。
设计了一种装置，通过在数天或数周内施加持续的低强度张力来使伤口边缘靠拢。迄今为止，已将一个或多个该装置应用于25例患者的伤口。
在那些最佳使用该装置的患者（20例）中实现了愈合。在5例患者中，由于社会经济原因无法实现最佳使用；这些原因包括不依从、保险问题、经济困难和个人因素。在这5例中，3例接受随访的患者实现了愈合，通过网格摄影估计全层皮肤覆盖范围在80%至90%之间。1例患者在伤口被全层皮肤覆盖95%后失访。1例伤口尺寸缩小的患者在治疗12天后拒绝进一步治疗。
似乎当对亚急性和慢性伤口施加持续张力、低强度力时，愈合会加速，并且根据伤口情况，相当数量的溃疡可以通过全层皮肤闭合。
