■在骨骼和肌腱暴露的情况下重建复杂的软组织缺损在伤口护理方面面临着越来越大的挑战,尤其是四肢大面积伤口.这项研究的目的是检测联合使用负压伤口治疗(NPWT)的临床疗效,人造真皮(ADM),富血小板血浆(PRP)和裂层植皮(STSG)在重建大型创伤性四肢皮肤缺损中的应用。
■在这项研究中,8例患者采用综合疗法修复复杂的四肢伤口,并对结果进行回顾性分析。手术清创术后,所有伤口都接受了ADM,PRP和延迟STSG,这些都是用NPWT辅助的。
■患者包括5名男性和3名女性,平均年龄44岁.共有六个下肢伤口位于脚/脚踝,五根肌腱外露,骨骼暴露在三个和两个。该组,两名患者的手臂/手伤口有暴露的肌腱。伤口和ADM的大小分别平均为126cm2和42.3cm2。ADM用于覆盖裸露的骨骼或肌腱,直接用负压封闭引流(VSD)覆盖肉芽和肌肉组织,对于NPWT。ADM的平均生存率为98.9%。ADM的平均存活时间为12.8天,自体皮肤移植物的平均摄取为93.5%。只有一名患者接受了反复的皮肤移植。所有患者均成功愈合,无并发症。平均住院时间为36.1天。
■我们的研究表明,ADM与NPWT结合使用,PRP和STSG可用于修复大型创伤性四肢伤口。无皮瓣伤口闭合,美学和功能结果是可以接受的,只有一名患者出现了35%的皮肤移植损失。
■这项工作得到了湖北省自然科学基金的资助(批准号:2020CFB464)和武汉市卫生健康委员会青年基金会(批准号。WX20Q15)。作者没有利益冲突要声明。
UNASSIGNED: The reconstruction of complex soft tissue defects with exposure of bones and tendons represents an increasing challenge in wound care, especially in large extremity wounds. The aim of this study was to detect the clinical efficacy of combined use of negative pressure wound therapy (NPWT), artificial dermis (ADM), platelet-rich plasma (PRP) and split-thickness skin grafting (STSG) in the reconstruction of large traumatic extremity skin defects.
UNASSIGNED: In this study, eight cases were treated with combined therapies for repairing complex extremity wounds and the results were reviewed retrospectively. After surgical debridement, all wounds received ADM, PRP and delayed STSG, which were all aided with NPWT.
UNASSIGNED: The patients consisted of five males and three females, with a mean age of 44 years. A total of six lower extremity wounds were located at the foot/ankle, with exposed tendon in five, bone exposure in three and both in two. Of the group, two patients had exposed tendon on arm/hand wounds. The size of wounds and ADM averaged 126cm2 and 42.3cm2, respectively. ADM was used to cover the exposed bone or tendon, the granulation and muscular tissue were covered with vacuum sealing drainage (VSD) directly, for NPWT. The survival rate of ADM averaged 98.9%. The average time for survival of ADM was 12.8 days and the mean uptake of autologous skin graft was 93.5%. Only one patient received repeated skin grafts. All patients achieved successful healing and reported no complications. The mean length of hospital stay was 36.1 days.
UNASSIGNED: Our study revealed that ADM in conjunction with NPWT, PRP and STSG could be used for repairing large traumatic extremity wounds. Wound closure was achieved without flaps, the aesthetic and functional outcomes were acceptable, and only one patient developed a 35% loss of skin graft.
UNASSIGNED: This work was supported by grants from the Natural Science Foundation of Hubei Province (grant no. 2020CFB464) and Youth Foundation of Wuhan Municipal Health Commission (grant no. WX20Q15). The authors have no conflicts of interest to declare.