毁损性创面的治疗进展
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摘要
毁损性创面目前尚没有一个明确的定义,临床上常常将由各种原因所致的皮肤、皮下组织缺损,伴有一定程度结构缺损及功能障碍甚至伴有深部组织较大范围的结构破坏者,通过简单治疗方法难以治愈的创面称之为毁损性创面。毁损性创面具有治疗难度大、周期长、预后不理想等特点。本文就毁损性创面的治疗进展进行总结,简述目前临床上常见的治疗方法,特别是特殊类型穿支皮瓣在毁损性创面修复中具有重要作用。结合笔者科室经验,我们认为毁损性创面应该以"创面外科整合治疗"的模式进行治疗。
There is still not a widely recognized definition of destructive wound.Clinically,skin and subcutaneous tissue defects caused by various reasons,accompanied by a certain degree of structural defects and dysfunction,and even a large degree of structural destruction of deep tissues,the wounds that are difficult to cure by simple treatment are called destructive wound.The destructive wounds have the characteristics of high treatment difficulty,long cycle and unsatisfactory prognosis.In this review,we will discuss the progress of treatment of destructive wounds,and briefly summary the current clinically common treatment methods,especially using special types of perforator flaps to repair of destructive wound.Based on the clinical experience of the author' s department,we believe that the destructive wound should be treated with the"integrated treatment of wound surgery"model.
There is still not a widely recognized definition of destructive wound.Clinically,skin and subcutaneous tissue defects caused by various reasons,accompanied by a certain degree of structural defects and dysfunction,and even a large degree of structural destruction of deep tissues,the wounds that are difficult to cure by simple treatment are called destructive wound.The destructive wounds have the characteristics of high treatment difficulty,long cycle and unsatisfactory prognosis.In this review,we will discuss the progress of treatment of destructive wounds,and briefly summary the current clinically common treatment methods,especially using special types of perforator flaps to repair of destructive wound.Based on the clinical experience of the author' s department,we believe that the destructive wound should be treated with the"integrated treatment of wound surgery"model.
引文
[1]柴家科.进一步重视烧(创)伤毁损性创面修复技术的研究[J/CD].中华损伤与修复杂志(电子版),2014,9(1):5-8.
[2]魏在荣.皮瓣命名方式探讨[J/CD].中华损伤与修复杂志(电子版),2011,6(3):9-11.
[3]张世民,唐茂林,章伟文,等.穿支皮瓣的名词术语与临床应用原则[J].中国临床解剖学报,2011,29(6):599-601.
[4]Deng C,Wu B,Wei Z,et al.Interperforator flow pattern and clinical application of distal extended peroneal artery perforator flaps[J].Annals of Plastic Surgery,2018,80(5):546-552.
[5]魏在荣.皮瓣血供模式分类方式初步报告[J].遵义医学院学报,2012,35(8):344-346.
[6]魏在荣.影响皮瓣成活的血管因素分析[J].中国美容整形外科志,2014,25(3):129-131.
[7]唐举玉,章伟文,张世民,等.中国特殊形式穿支皮瓣的名词术语与定义专家共识[J].中华显微外科杂志,2013,36(2):113-1146.
[8]张世民,唐茂林,章伟文,等.穿支皮瓣的名词术语与临床应用原则[J].中国临床解剖学杂志,2011,29(6):599-601.
[9]唐举玉,章伟文,张世民,等.中国特殊形式穿支皮瓣的名词术语与定义专家共识[J].中华显微外科杂志,2013,36(2):113-114.
[10]Soutar DS,Tanner NS.The radial forearm flap in the management of soft tissue injuries of the hand[J].Br J Plast Surg,1984,37(1):18-26.
[11]Kimura N.A microdissected thin tersor fasciae latae perforator flap[J].Plast Reconstr Surg,2002,109(1):69-77;discussion78-80.
[12]Rajacic N,Gang RK,Krishnan J,et al.Thin anterolateral thigh free flap[J].Ann Plast Surg.2002,48(3):252-257.
[13]Kimura N,Satoh K,Hosaka Y.Microdissected thin perforator flaps:46 cases[J].Plast Reconstr Surg,2003,112(7):1875-1885.
[14]Yang WG,Chiang YC,Wei FC,et al.Thin anterolateral thigh perforator flap using a modified perforator microdissection technique and its clinical application for foot resurfacing[J].Plast Reconstr Surg,2006,117(3):1004-1008.
[15]Chen YC,Scaglioni MF,Carrillo Jimenez LE,et al.Suprafascial Anterolateral Thigh Flap Harvest:A Better Way to Minimize Donor-Site Morbidity in Head and Neck Reconstruction[J].Plast Reconstr Surg,2016,138(3):689-698.
[16]Hallock GG.Further clarification of the nomenclature for compound flaps[J].Plast Reconstr Surg,2006,117(7):151e-160e.
[17]Koshima I,Yamamoto H,Hosoda M,et al.Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions:an introduction to the chimeric flap principle[J].Plast Reconstr Surg,1993,92(3):411-420.
[18]Hallock GG.An introduction to the chimeric deep inferior epigastric artery perforator(DIEAP)-rectus abdominis muscle flap[J].Ann Plast Surg,2008,61(5):580-583.
[19]魏在荣,汪华侨,王达利,等.穿支皮瓣供区选择原则[J].中华显微外科杂志,2016,39(5):417-419.
[20]雷晋,侯春胜,郝振明,等.烧创伤毁损性创面早期功能重建及外形修复[J/CD].中华损伤与修复杂志(电子版),2015,10(1):13-17.
[21]何晓清,徐永清,朱跃良.旋股外侧动脉降支远端血管在股前外侧皮瓣手术中的应用价值[J].中华显微外科杂志,2014,37(6):521-523.
[22]Kim SA,Ryu HW,Lee KS,et al.Application of platelet-rich plasma accelerates the wound healing process in acute and chronic ulcers through rapid migration and upregulation of cyclin A and CDK4 in Ha CaT cells[J].Mol Med Rep,2013,7(2):476-480.
[23]Morimoto N,Kakudo N,Matsui M,et al.Exploratory clinical trial of combination wound therapy with a gelatin sheet and platelet-rich plasma in patients with chronic skin ulcers:study protocol[J].BMJ Open,2015,5(5):e007733.
[24]Nishimoto S,Kawai K,Tsumano T,et al.Impacts of bone marrow aspirate and peripheral blood derived platelet-rich plasma on the wound healing in chronic ischaemic limb[J].J Plast Surg Hand Surg,2013,47(3):169-174.
[25]Chiaravalloti AJ,Zubkov B,Zubkov A.Treatment of a Chronic Cutaneous Surgical Wound With Platelet-Rich Fibrin[J].Dermatol Surg,2018,44(3):449-452.
[26]Bauer JW,Koller J,Murauer EM,et al.Closure of a Large Chronic Wound through Transplantation of Gene-Corrected Epidermal Stem Cells[J].J Invest Dermatol,2017,137(3):778-781.
[27]Deng C,He Y,Feng J,et al.Extracellular matrix/stromal vascular fraction gel conditioned medium accelerates wound healing in a murine model[J].Wound Repair Regen,2017,25(6):923-932.
[28]Supp DM,Bell SM,Morgan JR,et al.Genetic modification of cultured skin substitutes by transduction of human keratinocytes and fibroblasts with platelet-derived growth factor-A[J].Wound Repair Regen,2000,8(1):26-35.
[29]Mulholland EJ,Dunne N,Mc Carthy HO.MicroRNA as Therapeutic Targets for Chronic Wound Healing[J].Mol Ther Nucleic Acids,2017,8:46-55.
[30]Beitz JM.Wound debridement:therapeutic options and care considerations[J].Nurs Clin North Am,2005,40(2):233-249.
[31]Robson MC,Stenberg BD,Heggers JP.Wound healing alterations caused by infection[J].Clin Plast Surg,1990,17(3):485-492.
[2]魏在荣.皮瓣命名方式探讨[J/CD].中华损伤与修复杂志(电子版),2011,6(3):9-11.
[3]张世民,唐茂林,章伟文,等.穿支皮瓣的名词术语与临床应用原则[J].中国临床解剖学报,2011,29(6):599-601.
[4]Deng C,Wu B,Wei Z,et al.Interperforator flow pattern and clinical application of distal extended peroneal artery perforator flaps[J].Annals of Plastic Surgery,2018,80(5):546-552.
[5]魏在荣.皮瓣血供模式分类方式初步报告[J].遵义医学院学报,2012,35(8):344-346.
[6]魏在荣.影响皮瓣成活的血管因素分析[J].中国美容整形外科志,2014,25(3):129-131.
[7]唐举玉,章伟文,张世民,等.中国特殊形式穿支皮瓣的名词术语与定义专家共识[J].中华显微外科杂志,2013,36(2):113-1146.
[8]张世民,唐茂林,章伟文,等.穿支皮瓣的名词术语与临床应用原则[J].中国临床解剖学杂志,2011,29(6):599-601.
[9]唐举玉,章伟文,张世民,等.中国特殊形式穿支皮瓣的名词术语与定义专家共识[J].中华显微外科杂志,2013,36(2):113-114.
[10]Soutar DS,Tanner NS.The radial forearm flap in the management of soft tissue injuries of the hand[J].Br J Plast Surg,1984,37(1):18-26.
[11]Kimura N.A microdissected thin tersor fasciae latae perforator flap[J].Plast Reconstr Surg,2002,109(1):69-77;discussion78-80.
[12]Rajacic N,Gang RK,Krishnan J,et al.Thin anterolateral thigh free flap[J].Ann Plast Surg.2002,48(3):252-257.
[13]Kimura N,Satoh K,Hosaka Y.Microdissected thin perforator flaps:46 cases[J].Plast Reconstr Surg,2003,112(7):1875-1885.
[14]Yang WG,Chiang YC,Wei FC,et al.Thin anterolateral thigh perforator flap using a modified perforator microdissection technique and its clinical application for foot resurfacing[J].Plast Reconstr Surg,2006,117(3):1004-1008.
[15]Chen YC,Scaglioni MF,Carrillo Jimenez LE,et al.Suprafascial Anterolateral Thigh Flap Harvest:A Better Way to Minimize Donor-Site Morbidity in Head and Neck Reconstruction[J].Plast Reconstr Surg,2016,138(3):689-698.
[16]Hallock GG.Further clarification of the nomenclature for compound flaps[J].Plast Reconstr Surg,2006,117(7):151e-160e.
[17]Koshima I,Yamamoto H,Hosoda M,et al.Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions:an introduction to the chimeric flap principle[J].Plast Reconstr Surg,1993,92(3):411-420.
[18]Hallock GG.An introduction to the chimeric deep inferior epigastric artery perforator(DIEAP)-rectus abdominis muscle flap[J].Ann Plast Surg,2008,61(5):580-583.
[19]魏在荣,汪华侨,王达利,等.穿支皮瓣供区选择原则[J].中华显微外科杂志,2016,39(5):417-419.
[20]雷晋,侯春胜,郝振明,等.烧创伤毁损性创面早期功能重建及外形修复[J/CD].中华损伤与修复杂志(电子版),2015,10(1):13-17.
[21]何晓清,徐永清,朱跃良.旋股外侧动脉降支远端血管在股前外侧皮瓣手术中的应用价值[J].中华显微外科杂志,2014,37(6):521-523.
[22]Kim SA,Ryu HW,Lee KS,et al.Application of platelet-rich plasma accelerates the wound healing process in acute and chronic ulcers through rapid migration and upregulation of cyclin A and CDK4 in Ha CaT cells[J].Mol Med Rep,2013,7(2):476-480.
[23]Morimoto N,Kakudo N,Matsui M,et al.Exploratory clinical trial of combination wound therapy with a gelatin sheet and platelet-rich plasma in patients with chronic skin ulcers:study protocol[J].BMJ Open,2015,5(5):e007733.
[24]Nishimoto S,Kawai K,Tsumano T,et al.Impacts of bone marrow aspirate and peripheral blood derived platelet-rich plasma on the wound healing in chronic ischaemic limb[J].J Plast Surg Hand Surg,2013,47(3):169-174.
[25]Chiaravalloti AJ,Zubkov B,Zubkov A.Treatment of a Chronic Cutaneous Surgical Wound With Platelet-Rich Fibrin[J].Dermatol Surg,2018,44(3):449-452.
[26]Bauer JW,Koller J,Murauer EM,et al.Closure of a Large Chronic Wound through Transplantation of Gene-Corrected Epidermal Stem Cells[J].J Invest Dermatol,2017,137(3):778-781.
[27]Deng C,He Y,Feng J,et al.Extracellular matrix/stromal vascular fraction gel conditioned medium accelerates wound healing in a murine model[J].Wound Repair Regen,2017,25(6):923-932.
[28]Supp DM,Bell SM,Morgan JR,et al.Genetic modification of cultured skin substitutes by transduction of human keratinocytes and fibroblasts with platelet-derived growth factor-A[J].Wound Repair Regen,2000,8(1):26-35.
[29]Mulholland EJ,Dunne N,Mc Carthy HO.MicroRNA as Therapeutic Targets for Chronic Wound Healing[J].Mol Ther Nucleic Acids,2017,8:46-55.
[30]Beitz JM.Wound debridement:therapeutic options and care considerations[J].Nurs Clin North Am,2005,40(2):233-249.
[31]Robson MC,Stenberg BD,Heggers JP.Wound healing alterations caused by infection[J].Clin Plast Surg,1990,17(3):485-492.
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