PDF(Pubmed)
Abstract：
BACKGROUND: Necrotizing fasciitis (NF) is a serious infectious disease that can initially place the patient\'s life in danger and, after successful surgical and antibiotic treatment, leaves extensive wounds with sometimes even exposed bones and tendons. Autologous skin grafts are not always possible or require adequate wound bed preparation. Novel intact fish skin grafts (iFSGs; Kerecis® Omega3 Wound, Kerecis hf, Isafjördur, Iceland) have already shown their potential to promote granulation in many other wound situations. Faster wound healing rates and better functional and cosmetic outcomes were observed due to their additionally postulated anti-inflammatory and analgesic properties. Therefore, iFSGs may also be essential in treating NF. We present our initial experience with iFSGs in treating leg wounds after NF and review the literature for the current spectrum of clinical use of iFSGs.
METHODS: We present two male patients (aged 60 and 69 years) with chronic or acute postsurgical extensive leg ulcers six weeks and six days after necrotizing fasciitis, respectively. Both suffered from diabetes mellitus without vascular pathologies of the lower limbs. A single application of one pre-meshed (Kerecis® Graftguide) and one self-meshed 300 cm2 iFSG (Kerecis® Surgiclose) was performed in our operation room after extensive surgical debridement and single circles of negative wound pressure therapy. Application and handling were easy. An excellent wound granulation was observed, even in uncovered tibia bone and tendons, accompanied by pain relief in both patients. Neither complications nor allergic reactions occurred. The patients received autologous skin grafting with excellent functional and cosmetic outcomes.
CONCLUSIONS: iFSGs have the potential to play a significant role in the future treatment of NF due to the fast promotion of wound granulation and pain relief. Our experience may encourage surgeons to use iFSGs in NF patients, although high-quality, large-sized studies are still required to confirm these results. The observed effects of iFSGs on wounds associated with NF may be transferred to other wound etiologies as well.
METHODS: We present two male patients (aged 60 and 69 years) with chronic or acute postsurgical extensive leg ulcers six weeks and six days after necrotizing fasciitis, respectively. Both suffered from diabetes mellitus without vascular pathologies of the lower limbs. A single application of one pre-meshed (Kerecis® Graftguide) and one self-meshed 300 cm2 iFSG (Kerecis® Surgiclose) was performed in our operation room after extensive surgical debridement and single circles of negative wound pressure therapy. Application and handling were easy. An excellent wound granulation was observed, even in uncovered tibia bone and tendons, accompanied by pain relief in both patients. Neither complications nor allergic reactions occurred. The patients received autologous skin grafting with excellent functional and cosmetic outcomes.
CONCLUSIONS: iFSGs have the potential to play a significant role in the future treatment of NF due to the fast promotion of wound granulation and pain relief. Our experience may encourage surgeons to use iFSGs in NF patients, although high-quality, large-sized studies are still required to confirm these results. The observed effects of iFSGs on wounds associated with NF may be transferred to other wound etiologies as well.
摘要：
背景：坏死性筋膜炎（NF）是一种严重的传染病，最初会使患者的生命处于危险之中，经过成功的手术和抗生素治疗，留下广泛的伤口，有时甚至裸露的骨头和肌腱。自体皮肤移植物并不总是可能的或需要足够的伤口床准备。新型完整鱼皮移植物（iFSGs；Keeris®Omega3伤口，Keerishf，Isafjördur,冰岛）已经显示出在许多其他伤口情况下促进肉芽形成的潜力。观察到更快的伤口愈合率和更好的功能和美容结果,这是由于它们另外假定的抗炎和镇痛性质。因此,iFSGs在治疗NF中也可能是必需的。我们介绍了iFSGs在NF后治疗腿部伤口方面的初步经验，并回顾了目前iFSGs临床使用范围的文献。
方法：我们介绍了两名男性患者（年龄60岁和69岁）在坏死性筋膜炎后6周和6天患有慢性或急性术后广泛腿部溃疡，分别。两者都患有糖尿病，没有下肢血管病变。在我们的手术室中，在进行了广泛的手术清创术和单次负压伤口治疗后，进行了一次预网状（Keeriis®Graftguide）和一次自网状300cm2iFSG（Keeriis®Surgiclose）的单次应用。应用和处理很容易。观察到良好的伤口肉芽，即使在未发现的胫骨骨和肌腱中，伴随着疼痛缓解在两个病人。无并发症,无过敏反应发生。患者接受自体皮肤移植，具有出色的功能和美容效果。
结论：iFSGs有可能在未来治疗NF中起重要作用，因为它能快速促进伤口肉芽形成和缓解疼痛。我们的经验可能会鼓励外科医生在NF患者中使用iFSGs，虽然高质量，仍需要大型研究来证实这些结果。观察到的iFSGs对与NF相关的伤口的影响也可以转移到其他伤口病因。
方法：我们介绍了两名男性患者（年龄60岁和69岁）在坏死性筋膜炎后6周和6天患有慢性或急性术后广泛腿部溃疡，分别。两者都患有糖尿病，没有下肢血管病变。在我们的手术室中，在进行了广泛的手术清创术和单次负压伤口治疗后，进行了一次预网状（Keeriis®Graftguide）和一次自网状300cm2iFSG（Keeriis®Surgiclose）的单次应用。应用和处理很容易。观察到良好的伤口肉芽，即使在未发现的胫骨骨和肌腱中，伴随着疼痛缓解在两个病人。无并发症,无过敏反应发生。患者接受自体皮肤移植，具有出色的功能和美容效果。
结论：iFSGs有可能在未来治疗NF中起重要作用，因为它能快速促进伤口肉芽形成和缓解疼痛。我们的经验可能会鼓励外科医生在NF患者中使用iFSGs，虽然高质量，仍需要大型研究来证实这些结果。观察到的iFSGs对与NF相关的伤口的影响也可以转移到其他伤口病因。
