Healing of diabetic foot ulcers and pressure ulcers with human skin equivalent -: A new paradigm in wound healing
Healing of diabetic foot ulcers and pressure ulcers with human skin equivalent -: A new paradigm in wound healing
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DOI：
10.1001/archsurg.135.6.627
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发表时间：
2000-06-01
影响因子：
--
通讯作者：
Hollier, L
中科院分区：
文献类型：
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作者：
Brem, H;Balledux, J;Hollier, L
假设：在患有糖尿病足和压疮的患者中，早期生物疗法干预将阻止这些慢性伤口的进展或使其快速愈合。
设计：在一项前瞻性非随机病例系列研究中，23例连续患者在伤口切除清创后接受人皮肤等效物（HSE）治疗。
机构：一家大学教学医院及三级医疗中心。
患者与方法：23例连续患者共41处伤口（直径1.0 - 7.5厘米）在锐性切除清创后置入HSE进行治疗。所有压疮患者均使用零压力交替充气床垫进行交替空气疗法。
主要观察指标：伤口100%愈合的时间，定义为伤口完全上皮化且无渗出。
结果：10例糖尿病足溃疡患者中有7例所有伤口完全愈合。在这些患者中，20处伤口中有17处在平均42天内愈合。13例压疮患者中有7例所有伤口完全愈合。在压疮患者中，21处伤口中有13处在平均29天内愈合。本系列中所有未愈合的伤口均出现在伴有另外的Ⅳ期溃疡或有骨外露的伤口的患者中。30处愈合的伤口中有29处在单次应用HSE后愈合。
结论：在不同病程的糖尿病溃疡和压疮中，应用HSE并遵循传统皮肤移植的手术原则可成功促进愈合。这些不同类型伤口的高完全愈合成功率表明，HSE可能作为生长因子的储存库，同时刺激伤口收缩和上皮化。如果伤口在6周后未完全愈合，应再次应用HSE。如果伤口不愈合，隐匿性感染可能是原因。所有被识别并早期采用积极治疗（包括抗生素、减压和生物疗法）的非缺血性糖尿病足和压疮不会进展。
Hypothesis: In patients with diabetic foot and pressure ulcers, early intervention with biological therapy will either halt progression or result in rapid healing of these chronic wounds.Design: In a prospective nonrandomized case series, 23 consecutive patients were treated with human skin equivalent (HSE) after excisional debridement of their wounds.Setting: A single university teaching hospital and tertiary care center.Patients and Methods: Twenty-three consecutive patients with a total of 41 wounds (1.0-7.5 cm in diameter) were treated with placement of HSE after sharp excisional debridement, All patients with pressure ulcers received alternating air therapy with zero-pressure alternating air mattresses.Main Outcome Measure: Time to 100% healing, as defined by full epithelialization of the wound and by no drainage from the site.Results: Seven of 10 patients with diabetic foot ulcers had complete healing of all wounds. In these patients 17 of 20 wounds healed in an average of 42 days. Seven of 13 patients with pressure ulcers had complete healing of all wounds. In patients with pressure ulcers, 13 of 21 wounds healed in an average of 29 days. All wounds that did not heal in this series occurred in patients who had an additional stage IV ulcer or a wound with exposed bone. Twenty-nine of 30 wounds that healed did so after a single application of the HSE.Conclusions: In diabetic ulcers and pressure ulcers of various durations, the application of HSE with the surgical principles used in a traditional skin graft is successful in producing healing. The high success rate with complete closure in these various types of wounds suggests that HSE may function as a reservoir of growth factors that also stimulate wound contraction and epithelialization. If a wound has not fully healed after 6 weeks, a second application of HSE should be used, If the wound is not healing, an occult infection is the likely cause. All nonischemic diabetic foot and pressure ulcers that are identified and treated early with aggressive therapy (including antibiotics, off-loading of pressure, and biological therapy) will not progress.