Use of dermal regeneration template in contracture release procedures: A multicenter evaluation
Use of dermal regeneration template in contracture release procedures: A multicenter evaluation
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DOI：
10.1097/01.prs.0000111883.93604.85
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发表时间：
2004-04-15
影响因子：
3.6
通讯作者：
Burd, A
中科院分区：
文献类型：
--
作者：
Frame, JD;Still, J;Burd, A
Integra皮肤再生模板（Integra Life Sciences，Plainsboro，NJ）是治疗全层烧伤的有效方法它也可用于挛缩松解手术;然而，皮肤再生模板在挛缩松解手术中的临床用途尚未得到充分表征。在这项多中心研究中，回顾性评价了89例连续患者（共接受127次挛缩松解）采用真皮再生模板进行松解手术的结局。这些手术涉及Integra的应用，其中包括临时硅胶表皮替代物和人工真皮层。在形成新皮后，去除硅树脂层并用表皮自体移植物代替。通过标准化问卷收集患者和挛缩部位病史、治疗方法、医生对活动度或功能的评估、患者满意度、复发和不良事件的数据。研究患者的松解手术涉及颈部、腋窝、躯干、肘部、膝盖、手和其他解剖部位。平均术后随访时间为11.4个月。在76%的释放部位，医生将活动度或功能评定为良好（活动度或功能显著改善）或极好（可能的最大活动度或功能）。有反应的患者对82%的研究中心的总体治疗结果表示满意。在随访监测期间，75%的部位未观察到挛缩复发。患者年龄和既往手术治疗对治疗结果无显著影响。然而，在成熟部位，即，自原损害发生之日起超过12个月的。术后并发症很少需要再次移植。这些结果表明，真皮再生模板提供了一个有用的替代技术挛缩释放程序。研究数据表明，这种方法导致良好的功能结果和患者满意度高。这种方式似乎也是通用的，因为一系列的解剖部位都适合用真皮再生模板治疗，无论以前的手术治疗，儿科和成人患者都对这种形式的治疗反应良好。此外，Integra提供了与全层移植物相似的功能和美容益处，但没有供体部位发病的可比性。
Integra dermal regeneration template (Integra Life Sciences, Plainsboro, N.J.) is an effective treatment for full-thickness burns. It can also be useful in contracture release procedures; however, the clinical utility of a dermal regeneration template in contracture release procedures has not been adequately characterized. In this multicenter investigation, the outcomes of release procedures incorporating a dermal regeneration template for 89 consecutive patients, who underwent a total of 127 contracture releases, were retrospectively evaluated. The procedures involved the application of Integra, which includes a temporary silicone epidermal substitute and an artificial dermal layer. After formation of a neodermis, the silicone layer is removed and replaced with an epidermal antograft. Data on patient and contracture site history, treatment methods, physician assessments of range of motion or function, patient satisfaction, recurrence, and adverse events were collected with a standardized questionnaire. Release procedures for the study patients involved the neck, axilla, trunk, elbow, knee, hand, and other anatomical sites. The mean postoperative follow-up period was 11.4 months. At 76 percent of the release sites, range of motion or function was rated as good (significant improvement in range of motion or function) or excellent (maximal range of motion or function possible) by physicians. Responding patients expressed satisfaction with the overall results of treatment at 82 percent of the sites. No recurrence of contracture at 75 percent of the sites was observed during follow-up monitoring. Patient age and prior surgical treatment at the site did not significantly affect the results of treatment. However, outcomes were superior at mature sites, i.e., those for which more than 12 months had elapsed since the original injury. Postoperative complications rarely necessitated regrafting. These results indicate that a dermal regeneration template provides a useful alternative technique for contracture release procedures. The study data indicate that this approach leads to favorable functional outcomes and a high rate of patient satisfaction. This modality also seems to be versatile, because a range of anatomical sites are amenable to treatment with a dermal regeneration template, regardless of prior surgical treatment, and both pediatric and adult patients respond well to this form of therapy. Furthermore, Integra confers functional and cosmetic benefits similar to those of full-thickness grafts but without comparable potential for donor-site morbidity.