Outcomes of dermal regeneration template and split-thickness skin grafts in lower extremity wound closure: an 8-year retrospective analysis.

IF 1.4 4区医学 Q3 DERMATOLOGY

Wounds : a compendium of clinical research and practice Pub Date : 2025-02-01

Rachel N Rohrich, Karen R Li, Christian X Lava, Sami Alahmadi, Danny S Chamaa, Victoria H Kim, John S Steinberg, Jayson N Atves, Karen K Evans, Christopher E Attinger

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引用次数: 0

Abstract

Background: Split-thickness skin grafts (STSG) over tendon or bone often fail. In such cases, an attempt to create a neo-dermis or restore a dermal-like covering is indicated. This study compared the outcomes of dermal regeneration template (DRT) use in lower extremity (LE) wound closure when combined with STSG procedures.

Methods: Medical records of patients with chronic LE wounds who underwent STSG from 2014 to 2022 were reviewed. Wounds that were treated with DRT prior to STSG ("DRT") were compared those that were not ("non-DRT"). Both groups were acquired concurrently over the 8-year period. All outcomes evaluated were in relation to the STSG procedure.

Results: A total of 387 wounds in 261 patients were identified. One hundred seventy-three (43.5%) wounds were treated with DRT and 214 (55.3%) were not. No demographic differences were observed between the 2 groups. Prevalent comorbidities included diabetes (54.4%) and peripheral vascular disease (40.0%). Median wound size (28 cm2, interquartile range: 55) and depth were similar between the groups. The DRT group demonstrated significantly less graft failure than the non-DRT group (5.2% vs. 19.2%, respectively; P < .001) and higher rates of postoperative ambulation within 30 days (48.7% vs. 36.0%, respectively; P = .040) and 60 days (63.6% vs. 42.6%, respectively; P = .006). In a multivariate model, DRT independently reduced STSG failure and infection but not reoperation or amputation. Mortality trended to be lower in the DRT group (12.4% vs. 18.6%, P = .172).

Conclusions: DRT plays a key role as a temporizing measure to significantly enhance STSG take and promote ambulation in patients with chronic wounds but does not decrease the need for future major limb amputation.

本刊更多论文

真皮再生模板和分层厚皮移植在下肢伤口闭合中的效果：8 年回顾性分析。

背景：在肌腱或骨上进行裂厚皮肤移植（STSG）经常失败。在这种情况下，指示尝试创建新真皮层或恢复真皮样覆盖物。本研究比较了真皮再生模板（DRT）与STSG联合应用于下肢（LE）伤口愈合的结果。方法：回顾性分析2014 ~ 2022年慢性LE伤口行STSG的患者病历。在STSG之前接受DRT治疗的伤口（“DRT”）与未接受DRT治疗的伤口（“非DRT”）进行比较。这两组是在8年期间同时获得的。所有评估的结果都与STSG手术有关。结果：261例患者共发现387处伤口。173例（43.5%）伤口接受DRT治疗，214例（55.3%）伤口未接受DRT治疗。两组间无统计学差异。常见的合并症包括糖尿病（54.4%）和周围血管疾病（40.0%）。两组间中位伤口大小（28 cm2，四分位间距：55）和深度相似。DRT组的移植物衰竭明显低于非DRT组(分别为5.2%和19.2%；P < 0.001)，术后30天内下床率较高(分别为48.7% vs. 36.0%；P = 0.040)和60天(分别为63.6%对42.6%；P = .006)。在多变量模型中，DRT单独减少STSG失败和感染，但没有再手术或截肢。DRT组死亡率较低（12.4% vs. 18.6%, P = 0.172）。结论：DRT作为一种缓期措施，在显著增强慢性创伤患者的STSG反应和促进活动方面发挥了关键作用，但并没有减少未来主要肢体截肢的需要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Wounds : a compendium of clinical research and practice 医学-皮肤病学

CiteScore

1.50

自引率

11.80%

发文量

审稿时长

6-12 weeks

期刊介绍： Wounds is the most widely read, peer-reviewed journal focusing on wound care and wound research. The information disseminated to our readers includes valuable research and commentaries on tissue repair and regeneration, biology and biochemistry of wound healing, and clinical management of various wound etiologies. Our multidisciplinary readership consists of dermatologists, general surgeons, plastic surgeons, vascular surgeons, internal medicine/family practitioners, podiatrists, gerontologists, researchers in industry or academia (PhDs), orthopedic surgeons, infectious disease physicians, nurse practitioners, and physician assistants. These practitioners must be well equipped to deal with a myriad of chronic wound conditions affecting their patients including vascular disease, diabetes, obesity, dermatological disorders, and more. Whether dealing with a traumatic wound, a surgical or non-skin wound, a burn injury, or a diabetic foot ulcer, wound care professionals turn to Wounds for the latest in research and practice in this ever-growing field of medicine.