组织工程与重建外科杂志

组织工程与重建外科杂志 ›› 2022, Vol. 18 ›› Issue (4): 322-.

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双层人工真皮联合自体皮片移植修复手指皮肤软组织缺损伴骨、肌腱暴露创面的效果

  

  • 出版日期:2022-08-01 发布日期:2022-09-06

Clinical effect of bilayer artificial dermis combined with autologous skin graft for repairing finger skin soft tissue defect with tendon and bone exposure

  • Online:2022-08-01 Published:2022-09-06

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摘要： 目的　研究双层人工真皮联合自体皮片移植，修复手指皮肤软组织缺损伴骨、肌腱暴露创面的临床效果。方法　回顾性分析2020年9月至2021年10月收治的手指皮肤软组织缺损伴骨、肌腱暴露患者43例。使用双层人工真皮联合自体皮片移植者为观察组（n=16），使用带蒂皮瓣移植者为对照组（n=27）。观察比较两组患者治疗情况，包括两次手术间隔时间、皮片/皮瓣成活率和住院时间。术后3个月应用温哥华瘢痕量表（VSS）进行瘢痕评分；分别于术前、术后1、3个月对手指感觉恢复情况进行评分，并于术后3个月进行两点分辨觉测试。结果　对照组两次手术间隔时间、住院时间明显较观察组长（P<0.05），但两组患者皮片/皮瓣成活率无统计学差异（P>0.05）。术后3个月，患者均恢复良好，无明显皮片破溃表现。VSS评分结果显示，两组患者的修复部位色泽、血管分布及柔软度等无统计学差异（P>0.05），观察组厚度明显小于对照组（P<0.05）。观察组术后1、3个月时的感觉恢复评分明显高于对照组（P<0.05）；两组术后1、3个月感觉恢复评分明显高于术前，术后3个月评分高于术后1个月（P<0.05）。术后3个月时两组患者的两点分辨觉无明显差异（P>0.05）。结论　双层人工真皮联合自体皮片移植可有效修复手指小面积皮肤软组织缺损伴骨、肌腱暴露创面，国产双层人工真皮Lando较带蒂皮瓣移植修复术后恢复快，手指外形更美观，为临床修复此类创面提供了新的选择。

关键词: 双层人工真皮, 　自体皮片移植, 　肌腱外露, 　骨质外露

Abstract: Objective　To explore the clinical effect of bilayer artificial dermis combined with autologous skin graft in repairing skin and soft tissue defects of fingers with tendon and bone exposure. Methods　A total of 43 patients of finger skin and soft tissue defects with tendon and bone exposure admitted from September 2020 to October 2021 were retrospectively analyzed. Bilayer artificial dermis combined with autologous skin graft was used as the observation group (n=16) and pedicled flap was used as the control group (n=27). The treatment of the two groups were observed and compared, including the interval between two surgeries, the survival rate of skin graft/flap and the length of hospital stay. Vancouver scar scale (VSS) was used for scar score 3 months after operation. The recovery of finger sensation was scored before surgery, 1 month and 3 months after surgery, and two-point resolution test was performed 3 months after surgery. Results　The interval between two surgeries and  the length of hospital stay in the observation group were both significantly longer thanthose in the control group (P<0.05), while there was no significant difference in the survival rate of skin graft/flap between the two groups (P>0.05). All patients recovered well 3 months after operation without obvious skin ulceration. There were no significant differences in the color, vascular distribution and softness of VSS scores between the two groups (P>0.05), and the thickness of observation group was significantly lower than that of control group (P<0.05). The sensory recovery score of observation group was significantly higher than that of control group at 1 and 3 months after operation (P<0.05). The sensory recovery scores of the two groups 1 month and 3 months after surgery were significantly higher than before surgery, and the sensory recovery scores of the two groups 3 months after surgery were significantly higher than 1 month after surgery (P<0.05). Three months after surgery, there was no significant difference in patients' two-point resolution of the two groups(P>0.05). Conclusion　Bilayer artificial dermis combined with autologous skin graft can effectively repair the finger skin and soft tissue defects with tendon and bone exposure. Compared with pedicled skin flap, domestic bilayer artificial dermis Lando can achieve shorter hospital stay and more beautiful appearance of fingers, providing a new choice for clinical repair of such wounds.

Key words: Bilayer artificial dermis, 　Autologous skin graft, 　Tendon exposure, 　Bone exposure