Use of acellular dermal matrices in the treatment of trophic ulcers of the lower limbs

Introduction. The paper describes the experience with acellular dermal matrices (ADM) used in patients with trophic ulcers (TU) and their comparative analysis with traditional autodermoplasty (ADP) on granulation.

Subjects and methods. The early (10–14-day) and late (over a year) results were analyzed in 8 TU patients aged 25–55 years who used ADM – Integra Dermal Regeneration Template (IDRT) (INTEGRA Life Sciences Corporation, USA). All the patients with TU met the following criteria: an area of 25 to 150 cm2; a proliferative phase of the wound process; a defect duration of more than 12 months (during medical treatment). The patients were divided into 2 groups: 1) 5 female patients used IDRT (a two-layer variant); 2) 3 patients (2 women and 1 man) had IDRTSL (a one-layer variant). A comparison group consisted of 5 patients (3 women and 2 men) who underwent ADP on granulation without ADM. The patients were assessed by age, sex, TU site, extent, and etiology, disease duration, previous treatment, and the presence of comorbidities.

Results. On days 10–14, the mean autodermal graft retention rate in Groups 1 and 2 was 72.0 and 66.7 %, respectively, whereas that in the comparison group was 75 %. The shortest length of hospital stay was observed in the comparison group. However, within a year, 4 (80 %) of the 5 patients in this group were unsatisfied with the results of treatment, which was associated with recurrent TU or the development of hypertrophic ulcer. No recurrences were noted in the study groups (Groups 1 and 2). All the 8 (100 %) patients confirmed that the proposed treatment option met their expectations and reported their better quality of life.

1. Хирургические инфекции кожи и мягких тканей. Российские национальные рекомендации. Под ред. В.С. Савельева. М., 2009. 89 с. [Surgical infections of skin and soft tissues. Russian National Recommendations. Ed. by V.S. Savel’ev. Мoscow, 2009. 89 p. (In Russ.)].

2. Никитин В.Г., Оболенский В.Н., Родоман Г.В., Карев М.А. Трофические язвы нижних конечностей – обзор проблемы. Русский медицинский журнал 2009;(25):1647. [Nikitin V.G., Оbolenskiy V.N., Rodoman G.V., Karev М.А. Тrophic ulcers of lower extremities – problem review. Russkiy meditsinskiy zhurnal = Russian Medical Journal 2009;(25):1647. (In Russ.)].

3. Грачева С.А, Безводицкая А.А., Русаков В.А. и др. Аутодермопластика дефектов кожи, резвившихся в результате некротических форм рожистого воспаления, травм и последствий гнойно-воспалительных процессов. Медицинский журнал 2013;(3):60–4. [Grachevа S.А, Bezvoditskaya А.А., Rusakov V.А. et al. Аutodemoplasty of skin defects, developed as a result of necrotic forms of the fire, injuries and consequences of foul-inflammatory processes. Meditsinskiy zhurnal = Меdical Journal 2013;(3):60–4. (In Russ.)].

4. Абугалиев К.Р. Хирургическая обработка длительно незаживающих ожоговых ран. В сб.: Сборник научных трудов II Съезда комбустиологов России. 2008. С. 241–2. [Аbugaliev K.R. Surgical processing of the persistent burn wound. In: Volume of scientific works of the II Сonference of Russian Combustiologists. 2008. Pp. 241–2. (In Russ.)].

5. Светухин А.М., Аскеров Н.Г., Баткаев Э.А. и др. Современный подход к лечению трофических язв голени с перифокальной варикозной экземой, ассоциированной микотической инфекцией. Хирургия. Журнал им. Н.И. Пирогова 2008;(11):9–13. [Svetukhin А.М., Аskerov N.G., Batkaev E.А. et al. Modern approach to the treatment of trophic lower lef ulcers with perifocal varicose eczema, associated with micotic infection. Khirurgiya. Zhurnal im. N.I. Pirogova = Surgery. N.I. Pirogov Journal 2008;(11):9–13. (In Russ.)].

6. Липатов К.В., Комарова Е.А. Пластическое закрытие постнекрэктомических ран при осложненных формах рожи. Врач 2008;(1):52–3. [Lipatov K.V., Komarova Е.А. Plastic closing of postnecrectomic wound and complicated forms of fire. Vrach = Physician 2008;(1):52–3. (In Russ.)].

7. ШаблинД.В., ПавленкоС.Г., ЕвглевскийА.А. и др. Современные раневые покрытия в местном лечении ран различного генеза. Фундаментальные исследования 2013;(12):361–5. [Shablin D.V., Pavlenkо S.G., Еvglevskiy А.А. et al. Modern wound coatings in the local treatment of wounds of different genesis. Fundamental’nye issledovaniya = Fundamental Studies 2013;(12):361–5. (In Russ.)].

8. Lee K.H. Tissue-engineered human living skin substitutes: development and clinical application. Yonsei Med J 2000;41(6):774–9. DOI: 10.3349/ ymj.2000.41.6.774. PMID: 11204828.

9. Suh H., Hong J.P. One stage allogenic acellular dermal matrices (ADM) and split-thickness skin graft with negative pressure wound therapy. In: Skin grafts. Ed. by M. Gore. InTech, 2013. Ch. 4. Pp. 35–50.

10. Canonico S., Campitiello F., Corte A. et al. Treatment of leg chronic wounds with dermal substitutes and thin skin grafts. In: Skin grafts. Ed. by M. Gore. InTech, 2013. Ch. 5. Pp. 51–77.

11. Zavan B., Vindigni V., Corvito R., Abatangelo G. Skin substitutes. In: Tissue engineering. Ed. by D. Eberli. InTech, 2010. Ch. 25. Pp. 509–24.

12. Scalise A., Torresetti M., Grassetti L., Di Benedetto G. Acellular dermal matrix and skin grafts: A long-lasting alternative for weightbearing zone reconstruction after degloving trauma of the foot. Musculoskelet Regen 2015;2:e1048. DOI: 10.14800/mr.

13. Stern R., McPherson M., Longaker M.T. Histologic study of artificial skin used in the treatment of full-thickness thermal injury. J Burn Care Rehabil 1990;11(1):7–13. PMID: 2179224.

14. Усов В.В., Рева Г.В., Митряшов К.В. Применение искусственного заменителя кожи INTEGRA DERMAL REGENERATION TEMPLATE (IDRT) в лечении трофических язв нижних конечностей. Всб.: Диагностикаилечение острых венозных тромбозов и хронической венозной недостаточности. Сборник тезисов 5-го Санкт-Петербургского венозного форума. СПб., 2012. С. 77. [Usov V.V., Revа G.V., Мitryashov K.V. Applicaton of the artificial skin substitute INTEGRA DERMAL REGENERATION TEMPLATE (IDRT) in the treatment of trophic ulcers of lower extremities. In: Diagnostics and treatment of acute venous thrombosis and of the chronic venous failure. Volume of thesis of the 5th Saint-Petersburg Venous Forum. Saint Petersburg, 2012. P. 77. (In Russ.)].

15. Митряшов К.В., Усов В.В., Рева Г.В. Применение искусственного заменителя кожи INTEGRA DERMAL REGENERATION TEMPLATE (IDRT) для устранения послеожоговых контрактур шеи. В сб.: Сборник материалов II Национального конгресса «Пластическая хирургия». М., 2012. С. 11–2. [Мitryashov K.V., Usov V.V., Revа G.V. Applicaton of the artificial skin substitute INTEGRA® DERMAL REGENERATION TEMPLATE (IDRT) for the elimination of the post burn contracture of the neck. In: Volume of materials of the II National Congress “Plastic Surgery” . Мoscow, 2012. Pp. 11–2. (In Russ.)].

16. INTEGRA Dermal Regeneration Template. Treatment Guidelines. URL: http://www.integralife.com/products (last access date 08.05.2016).

17. Комарова Е.А. Особенности свободной кожной пластики ран расщепленным кожным лоскутом в гнойной хирургии. Автореф. дис. … канд. мед. наук. М., 2009. 24 с. [Komarovа Е.А. Peculiarities of the free skin plastics of wound with the split-thickness skin graft in the purulent surgery. Author’s abstract of thesis … of candidate of medicine. Moscow, 2009. 24 p. (In Russ.)].

18. Савченко Ю.П. Методы определения размеров раневой поверхности. Вестник хирургии 2007;(1):102–5. [Savchenkо Yu.P. Меthods of determination of the wound surface sizes. Vestnik khirurgii = Surgery Herald 2007;(1):102–5. (In Russ.)].

19. Богдан В.Г., Толстов Д.А. Клиническая эффективность аутодермопластики с использованием обогащенной тромбоцитами аутоплазмы при пластическом закрытии трофических язв венозной этиологии больших размеров. Военная медицина 2015;(2):65–9. [Bogdan V.G., Тоlstov D.А. Clinical efficiency of the autodermoplasty, using the autoplasma, enriched with thrombocytes at plastic closure of large trophic ulcers of venous etiology. Voennaya meditsina = Military Medicine 2015;(2):65–9. (In Russ.)].