Clinical efficacy of human biological dressing transplantation for refractory wounds in middle-aged and elderly patients

To evaluate the clinical efficacy of human biological dressing (human acellular dermal matrix) transplantation in the management of refractory wounds among middle-aged and elderly patients. A retrospective observational study was conducted involving 104 middle-aged and elderly patients (74 males, 30 females; aged 56-95 years) with refractory wounds treated at the First Affiliated Hospital of Wenzhou Medical University from January 2023 to December 2024. Following debridement, wound areas ranged from 1.0 to 48.0 cm². All patients received vacuum sealing drainage for 7 days, followed by human biological dressing transplantation. Subsequent wound management was determined based on wound status and patient preference: patients with wounds ≥2 cm² who consented underwent autologous skin grafting (ASG); those who declined ASG or had wounds <2 cm² received regular dressing changes. Outcome measures included: post-human biological dressing coverage of exposed tendons/bones and occurrence of tendon infection/osteomyelitis; survival rate of ASG at postoperative day 7; healing time in patients managed with dressing changes alone; patient satisfaction; and changes in pain intensity, sleep disturbance, and anxiety scores assessed before and 1 month after human biological dressing transplantation using the Edmonton Symptom Assessment Scale. After human biological dressing transplantation, 103 patients exhibited robust granulation tissue formation achieving complete coverage of exposed tendons/bones, with no instances of tendon/bone necrosis, infection, or osteomyelitis. Among these, 51 patients underwent successful ASG at (44.4±13.0) days post-human biological dressing (success rate 100.0%). The remaining 52 patients achieved primary wound healing through dressing changes alone within (62.6 ±13.4) days post-human biological dressing. One patient experienced human biological dressing dissolution and detachment due to gluteal wound infection, resulting in non-healing. The overall cure rate was 99.04% (103/104). Patient satisfaction was high: 95 very satisfied, 8 satisfied, and 1 dissatisfied (satisfaction rate 99.04%). Pain, sleep disturbance, and anxiety scores at 1 month post-human biological dressing were significantly reduced compared to pre-transplantation scores (all P<0.05). Human biological dressing transplantation is an effective therapeutic strategy for managing refractory wounds in middle-aged and elderly patients, demonstrating excellent outcomes in promoting granulation tissue growth, facilitating subsequent wound closure, and improving patient-reported symptoms.