Different Strategies for the Application of the Acellular Dermal Matrix in Treating Difficult Wounds

應用去細胞真皮基質的在處理困難傷口的不同策略

Yi-Ru Su(蘇羿如)；Chi-Ming Pu(蒲啟明)；Yu-Hsiu Yen(顏毓秀)

acellular dermis ； arterial occlusive disease ； diabetic foot ； wound healing

臺灣整形外科醫學會雜誌

33卷2期（2024 / 06 / 01）

174 - 188

英文;繁體中文

Background: As an effective scaffold and soft tissue augmentation, the acellular dermal matrix accelerated revascularization and cellular repopulation, leading to better wound healing. Therefore, the acellular dermal matrix is another treatment option for surgeons to consider when dealing with complicated wounds. Aim and objectives: We aimed to demonstrate that the acellular dermal matrix could be used in the treatment of various types of wounds with favorable results. Material and methods: Patients who had complex wounds and who underwent acellular dermal matrix therapy performed by two surgeons from May 2017 to Dec 2021 were included in this retrospective, single-center study. Based on our examinations, the wounds were classified acute wounds or chronic wounds. Different clinical application of acellular dermal matrix would be introduced including acellular dermal matrix only, acellular dermal matrix and split-thickness skin graft placement simultaneously, and two-stage procedure with acellular dermal matrix placement and delayed split-thickness skin graft placement. Results: Of the 30 included patients, fifteen had acute wounds, fifteen had chronic wounds. Peripheral arterial occlusive disease and diabetes mellitus were the main reasons for the chronic wounds. The extremities were the most affected sites. Four wounds were further complicated with tendon or bone exposure and two wounds were complicated with metal plate exposure. Twenty-eight patients achieved complete re-epithelialization and functional regain. Only two patients experienced acellular dermal matrix loss and underwent a free tissue transfer. Conclusion: ADM exerts beneficial effects on dermal regeneration, early neovascularization, cellular repopulation, and re-epithelialization, all crucial components of the wound healing process. In our study, we successfully employed ADM in the treatment of wounds associated with peripheral artery disease, poorly healing wounds, and traumatic injuries. Furthermore, we have suggested an algorithm about traumatic wound management especially at joint area and shared our experience with using this treatment modality to achieve satisfying results.

背景：去細胞真皮基質可以加速血管新生和細胞再生，作為一種癒合過程的傷口床支架及軟組織的基質進而促進傷口更好地癒合。因此，去細胞真皮基質是在處理複雜傷口時可以考慮的另一種治療選擇。目的及目標：本研究探討去細胞真皮基質可用於治療各種類型的傷口，並獲得良好的結果。材料及方法：本回顧性研究蒐集單一醫學中心研自2017年5月至2021年12月期間由兩位醫師使用去細胞真皮基質治療的複雜傷口患者。這些傷口被分為急性傷口或慢性傷口，手術方式分別為單獨使用去細胞真皮基質、使用去細胞真皮基質後再行植皮手術、同時使用去細胞真皮基質及植皮。結果：在30位案例中，有15位病患有急性傷口，另外15位患者有慢性傷口。周邊動脈阻塞疾病和糖尿病是慢性傷口的主要原因。四個傷口合併肌腱或骨頭暴露，而兩個傷口則合併金屬板暴露。有28位患者傷口完全癒合並且恢復功能。只有兩位患者出現去細胞真皮基質損失，後續接受了游離皮瓣手術。結論：去細胞真皮基質對於真皮層再生、早期血管新生、細胞新生和傷口再上皮化等傷口癒合過程中的關鍵部分具有很好的效益。在我們的研究中，我們成功地應用去細胞真皮基質治療了與周邊動脈疾病、癒合不良的傷口和創傷性損傷相關的傷口。此外，我們提出了一個針對創傷性傷口尤其是在關節區域的治療流程圖，並分享了我們使用去細胞真皮基質取得滿意結果的經驗。