PDF(Pubmed)
Abstract：
UNASSIGNED: Late-effect radiation-induced wounds represent a particularly difficult category of wounds to manage and treat. Fibrosis, impaired cellular activity, ischemia, and wound chronicity all work to impair healing, and this becomes more pronounced when defects are large or when avascular structures such as bone are exposed. Effective treatment options for this type of wound are limited. Thorough excision of irradiated tissue followed by distal pedicled or free flap closure is the most successful; however, this often requires multiple-stage surgeries and prolonged hospitalization and is associated with significant donor site morbidity. This is complicated further when wounds are large or in difficult locations, when surgery is not appropriate, or when there is limited access to surgeons with the appropriate experience/skill to perform such procedures.
UNASSIGNED: This case series describes the use of an autologous heterogenous skin construct (AHSC) made from a small full-thickness sample of the patient\'s healthy skin. Three patients with intractable late-effect radiation wounds were treated with AHSC. Case 1 describes an abdominal wound with tunneling of 7.5 cm to the pubic symphysis, which had been treated for known osteomyelitis, and a shallower full-thickness groin wound. Case 2 describes a right scapular wound with exposed bone, which had failed flap closure. Case 3 describes a right thigh wound in a patient who had been treated for sarcoma with extensive radiation therapy. This eventually resulted in an above-the-knee amputation, which failed to heal, and full exposure of the distal end of the resected femur. All wounds had been present for greater than 10 months.
UNASSIGNED: Mean percent volume reduction was 83% (±2.7) at 3 weeks and 92.9% (±4.7) at 4 weeks. The tunneled abdominal wound decreased in depth from 7.5 cm to 1.2 cm in 3 weeks. Complete closure was achieved at 11 weeks for the abdominal and groin wounds (patient 1) and at 16 weeks for the thigh wound (patient 3). The scapular wound volume of patient 2 had decreased by 91.8% at week 4 but was not fully restored until week 21. Mean time to closure was 16.1 (±4.7) weeks.
UNASSIGNED: AHSC was effective in covering exposed bone, improving wound bed vascularity, filling in significant wound depth, and achieving complete wound closure with one application in patients with intractable late-effect radiation wounds.
UNASSIGNED: This case series describes the use of an autologous heterogenous skin construct (AHSC) made from a small full-thickness sample of the patient\'s healthy skin. Three patients with intractable late-effect radiation wounds were treated with AHSC. Case 1 describes an abdominal wound with tunneling of 7.5 cm to the pubic symphysis, which had been treated for known osteomyelitis, and a shallower full-thickness groin wound. Case 2 describes a right scapular wound with exposed bone, which had failed flap closure. Case 3 describes a right thigh wound in a patient who had been treated for sarcoma with extensive radiation therapy. This eventually resulted in an above-the-knee amputation, which failed to heal, and full exposure of the distal end of the resected femur. All wounds had been present for greater than 10 months.
UNASSIGNED: Mean percent volume reduction was 83% (±2.7) at 3 weeks and 92.9% (±4.7) at 4 weeks. The tunneled abdominal wound decreased in depth from 7.5 cm to 1.2 cm in 3 weeks. Complete closure was achieved at 11 weeks for the abdominal and groin wounds (patient 1) and at 16 weeks for the thigh wound (patient 3). The scapular wound volume of patient 2 had decreased by 91.8% at week 4 but was not fully restored until week 21. Mean time to closure was 16.1 (±4.7) weeks.
UNASSIGNED: AHSC was effective in covering exposed bone, improving wound bed vascularity, filling in significant wound depth, and achieving complete wound closure with one application in patients with intractable late-effect radiation wounds.
摘要：
■迟效辐射诱导的伤口代表特别难以管理和治疗的伤口类别。纤维化,细胞活动受损，缺血,和伤口慢性都会损害愈合，当缺陷很大或骨等无血管结构暴露时，这种情况会变得更加明显。这种类型的伤口的有效治疗选择是有限的。彻底切除受照射的组织，然后远端带蒂或游离皮瓣闭合是最成功的；然而，这通常需要多阶段手术和长期住院,并且与显著的供体部位发病率相关.当伤口很大或在困难的位置时，这更加复杂，当手术不合适时，或者当具有适当经验/技能的外科医生进行此类手术的机会有限时。
本病例系列描述了使用由患者健康皮肤的小的全厚度样本制成的自体异质皮肤构建体(AHSC)。用AHSC治疗了三名顽固性迟效放射伤口的患者。病例1描述了腹部伤口，耻骨联合隧道长度为7.5厘米，已经治疗了已知的骨髓炎，和一个较浅的全厚度腹股沟伤口。案例2描述了右肩胛骨伤口裸露，皮瓣闭合失败。病例3描述了一名接受过广泛放射治疗的肉瘤患者的右大腿伤口。这最终导致膝盖以上截肢，未能治愈，以及切除股骨远端完全暴露。所有伤口都存在超过10个月。
3周时的平均体积减少百分比为83%(±2.7),4周时为92.9%(±4.7)。腹部隧道伤深度在3周内从7.5cm下降到1.2cm。腹部和腹股沟伤口（患者1）在11周时完全闭合，大腿伤口（患者3）在16周时完全闭合。患者2的肩胛骨创伤体积在第4周减少了91.8%,但直到第21周才完全恢复。平均闭合时间为16.1(±4.7)周。
■AHSC可有效覆盖裸露的骨骼，改善伤口床血管分布，填充在显著的伤口深度，并在难治性晚期效果放射伤口患者中通过一次应用实现伤口完全闭合。
本病例系列描述了使用由患者健康皮肤的小的全厚度样本制成的自体异质皮肤构建体(AHSC)。用AHSC治疗了三名顽固性迟效放射伤口的患者。病例1描述了腹部伤口，耻骨联合隧道长度为7.5厘米，已经治疗了已知的骨髓炎，和一个较浅的全厚度腹股沟伤口。案例2描述了右肩胛骨伤口裸露，皮瓣闭合失败。病例3描述了一名接受过广泛放射治疗的肉瘤患者的右大腿伤口。这最终导致膝盖以上截肢，未能治愈，以及切除股骨远端完全暴露。所有伤口都存在超过10个月。
3周时的平均体积减少百分比为83%(±2.7),4周时为92.9%(±4.7)。腹部隧道伤深度在3周内从7.5cm下降到1.2cm。腹部和腹股沟伤口（患者1）在11周时完全闭合，大腿伤口（患者3）在16周时完全闭合。患者2的肩胛骨创伤体积在第4周减少了91.8%,但直到第21周才完全恢复。平均闭合时间为16.1(±4.7)周。
■AHSC可有效覆盖裸露的骨骼，改善伤口床血管分布，填充在显著的伤口深度，并在难治性晚期效果放射伤口患者中通过一次应用实现伤口完全闭合。
