Treatment of Stage 4 Pressure Injuries With Autologous Heterogenous Skin Construct: A Single-Center Retrospective Study.

Eplasty Pub Date : 2023-01-01
Diana Burgueño-Vega, Dilip Shahani, Ryan Mathis, Melodie Blakely
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Abstract

Background: Pressure injuries (PIs) are a challenging problem in health care affecting 2.5 million people per year in the US, with 60,000 deaths directly attributed to PIs annually. Surgical closure is the treatment of choice for stage 3 and 4 PIs, but with complication rates of 59% to 73%, less invasive and more effective treatments are needed. Autologous heterogeneous skin construct (AHSC) is a novel autograft made from a small full-thickness harvest of healthy skin. This single-center retrospective cohort study sought to determine the effectiveness of AHSC in the treatment of recalcitrant stage 4 pressure injuries.

Methods: All data were collected retrospectively. The primary efficacy outcome was complete wound closure. Secondary efficacy outcomes included percent area reduction, percent volume reduction, and coverage of exposed structures.

Results: Seventeen patients with 22 wounds were treated with AHSC. Complete closure was achieved in 50% of patients in a mean time of 146 (SD ± 93) days, and the percent area and volume reductions were 69% and 81%, respectively. A 95% volume reduction was achieved in 68.2% of patients at a mean time of 106 (SD ± 83) days, and critical structures were fully covered in 95% of patients in a mean time of 33 (SD ± 19) days. After AHSC treatment, there was a mean decrease of 1.65 hospital admissions (P = .001), 20.92 hospital days (P < .001), and 2.36 operative procedures per year (P < 0.001).

Conclusions: AHSC demonstrated the ability to cover exposed structures, restore wound volume, and achieve durable wound closure in chronic refractory stage 4 PIs with better closure and recurrence rates than current surgical and nonsurgical treatments. AHSC represents a minimally invasive alternative to reconstructive flap surgery that preserves future reconstructive options while minimizing donor-site morbidity and promoting improved patient health.

自体异质皮肤结构治疗4期压伤:一项单中心回顾性研究。
背景:压力性损伤(PIs)是医疗保健中的一个具有挑战性的问题,每年在美国影响250万人,每年有6万人直接死于PIs。手术关闭是3期和4期pi的治疗选择,但并发症发生率为59%至73%,需要更少侵入性和更有效的治疗。自体异质皮肤结构(AHSC)是一种由少量全层健康皮肤制成的新型自体移植物。这项单中心回顾性队列研究旨在确定AHSC治疗顽固性4期压力损伤的有效性。方法:回顾性收集所有资料。主要疗效指标为伤口完全愈合。次要疗效指标包括面积缩小百分比、体积缩小百分比和暴露结构的覆盖率。结果:17例22处创面均采用AHSC治疗。50%的患者在146 (SD±93)天的平均时间内完全闭合,面积和体积缩小的百分比分别为69%和81%。68.2%的患者在平均106 (SD±83)天内实现了95%的体积缩小,95%的患者在平均33 (SD±19)天内完全覆盖了关键结构。AHSC治疗后,平均每年住院人数减少1.65人(P = 0.001),住院天数减少20.92天(P < 0.001),手术次数减少2.36次(P < 0.001)。结论:AHSC能够覆盖暴露的结构,恢复伤口体积,并在慢性难治性4期pi中实现持久的伤口愈合,比目前的手术和非手术治疗具有更好的愈合和复发率。AHSC代表了重建皮瓣手术的一种微创选择,保留了未来的重建选择,同时最大限度地减少了供体部位的发病率,促进了患者健康的改善。
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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