PDF(Pubmed)
Abstract：
Chronic soft tissue defects are notoriously difficult to heal. Surgical reconstruction of chronic defects using tissue flaps is a routine approach for closure of challenging chronic defects. Due to the poor tissue quality of chronic defects and associated inflammation, infection and impaired blood supply the success of flap closure is marred by reported complication rates of 25-58%. Extracellular matrix (ECM)-based graft materials are commonly used for resolving chronic wounds and in plastic and reconstructive procedures to create a scaffold for tissue regeneration. We hypothesized combination use of ECM grafts with tissue flaps in a single-stage surgical procedure would reduce complications and improve outcomes in the closure of chronic soft tissue defects. We report a case series (n = 9) of chronic soft tissue defect reconstruction using this modified procedure of ECM graft augmented flap closure. Defects included pressure injuries and surgical dehiscence and ranged in wound age from 5 months to 7 years. Successful uncomplicated healing was achieved in six defects. Post-operative complications (dehiscence) occurred in two defects, however, these healed via secondary intention without additional surgical intervention. All healed defects exhibited acceptable cosmesis and \"normal\" function, with 100% patient satisfaction. Augmentation of tissue flaps with ECM graft materials in this modified single-stage procedure may improve outcomes and minimize typical complications encountered in flap closure of chronic defects attributed to inflammation, infection, hypoperfusion, and dead space.
摘要：
众所周知，慢性软组织缺损难以治愈。使用组织瓣手术重建慢性缺损是闭合具有挑战性的慢性缺损的常规方法。由于慢性缺陷和相关炎症的组织质量差，感染和血液供应受损，据报道并发症发生率为25-58％，损害了皮瓣闭合的成功率。基于细胞外基质(ECM)的移植材料通常用于解决慢性伤口以及用于制造用于组织再生的支架的塑料和重建程序。我们假设在单阶段外科手术中结合使用ECM移植物和组织瓣将减少并发症并改善慢性软组织缺损闭合的结果。我们报告了使用这种改良的ECM移植物增强皮瓣闭合程序进行慢性软组织缺损重建的病例系列（n=9）。缺陷包括压力损伤和手术裂开，伤口年龄为5个月至7岁。在六个缺陷中成功实现了简单的愈合。术后并发症（裂开）发生在两个缺损，然而,这些患者通过次要意图治愈，无需额外的手术干预。所有治愈的缺陷都表现出可接受的美容和“正常”功能，100%患者满意度在这种改良的单阶段手术中，用ECM移植材料增强组织瓣可以改善预后，并最大程度地减少由于炎症引起的慢性缺损的皮瓣闭合中遇到的典型并发症。感染,灌注不足,死的空间。
