背景:自2017年以来,IFSG的临床使用在美国大幅增加,在欧洲和亚洲也有一些用途。然而,关于这种使用的共识数据很少。
目的:作者试图为IFSG在急性和慢性LEW治疗中的临床应用提供共识建议。
方法:美国的一个由8名临床专家组成的小组根据自己的临床实践和文献,使用2个周期的NFG程序来制定共识声明。在2021年10月的首次会议上,小组成员讨论了DFU的管理,VLU,非典型LEW,以及他们实践中的创伤性LEW。起草了共识声明,投票,并按相对重要性进行评级。在2022年10月的第二次会议上,小组讨论了初步调查结果;进行了第二次调查,小组成员修订了建议,并在最终报告中指出了每个建议的相对重要性。还对2016年1月至2022年11月发表的英语文章进行了系统的文献综述,使用搜索词:“鱼皮,\"\"鱼皮移植,“\”鱼组织,“\”完整的鱼皮移植,\"\"鳕鱼皮,“”Omega3脂肪酸接枝。\"
结果:生成了43个陈述,并将其分为5个部分,包括对LEW的一般建议和针对DFU的建议,VLU,非典型LEW,和创伤性LEW。主要的一般建议是需要根据临床评估和审查相关测试结果来确定伤口病因。对于DFU和VLU,主要建议是坚持一线治疗(即,护理标准,遵循常规指南[多层压迫疗法],卸载,并评估伤口灌注),然后再引入IFSG。
结论:在过去几年中,使用IFSGs的出版物和临床经验大幅增加。43项共识建议旨在指导医生在急性和慢性LEW的管理中最佳使用IFSG。
Since 2017, the clinical use of IFSG has increased substantially in the United States, with some use in Europe and Asia as well. However, scant
consensus data have been published on such use.
The authors sought to develop
consensus recommendations for the clinical use of IFSG in the management of acute and chronic LEWs.
A panel of 8 expert clinicians in the United States used a 2-cycle NFG process to develop
consensus statements based on their own clinical practice and the literature. At their initial meeting in October 2021, panel members discussed the management of DFUs, VLUs, atypical LEWs, and traumatic LEWs in their practices.
Consensus statements were drafted, voted on, and rated by relative importance. At the second meeting in October 2022, the panel discussed the initial survey results; a second survey was conducted, and panel members revised the recommendations and indicated the relative importance of each in the final report. A systematic literature review of English-language articles published from January 2016 through November 2022 was conducted as well, using the search terms: \"fish skin,\" \"piscine graft,\" \"fish tissue,\" \"intact fish skin graft,\" \"Cod skin,\" \"Omega 3 fatty acid graft.\"
Forty-three statements were generated and grouped into 5 sections comprising general recommendations for LEWs and recommendations specific to DFUs, VLUs, atypical LEWs, and traumatic LEWs. The primary general recommendation is the need to determine wound etiology based on clinical evaluation and reviewing related test results. For DFUs and VLUs, the main recommendations are to adhere to first-line therapy (ie, standard of care, follow conventional
guidelines [multilayer compression therapy], offloading, and assessment of wound perfusion) before introducing IFSG.
Publications on and clinical experience in the use of IFSGs have increased substantially in the past several years. The 43 consensus recommendations are meant to guide physicians in the optimal use of IFSG in the management of acute and chronic LEWs.