肢体关节部位挛缩瘢痕整形术中复合皮移植的应用

Clinical application of composite skin graft in the contracted scar plasty surgery of limb's joint

目的探讨肢体关节部位挛缩瘢痕整形术中脱细胞异体真皮基质与自体表皮复合移植的应用。方法四肢关节部位(选取肘关节、腕关节、膝关节和距小腿(踝)关节)挛缩瘢痕24例(共34个关节)行局部切除松解后,以脱细胞异体真皮基质与自体表皮构成复合皮,对创面行Ⅱ期修复,观察复合植皮成活率、外观、质地、关节功能改善等情况。结果术后第14天34个关节的复合植皮成活率96.3%,肘、腕、膝、踝四个部位的移植成活率差异无统计学意义(P>0.05),随访6～20个月移植复合皮局部接近正常皮肤颜色和质地,关节功能较术前明显改善。结论在肢体关节部位的挛缩瘢痕整形术中应用复合皮移植是目前比较理想的方法,愈后外观、质地良好,关节功能改善满意,对自体皮源稀缺患者尤为适用。

Objective To investigate the effect of clinical application of composite skin graft consisting of acellular allogenic dermis and autologous skin in the contracted scar plasty surgery of limb＇ s joint. Methods 24 cases of patients of contracted scar（ total thirty four joints） of the limb＇ s joint（ selecting elbow joint, carpal joints knee joint and ankle joint）were selected. After local resection of scar, the wound was repaired by the composite skin graft consisting of acellular allogenic dermis and autologous skin. Observation of survival rate of grafted composite skin,and the improvement of appearance,tenacity and function of the joints. Results 14 days later,the survival rate of grafted composite skin was 96. 3 percent. There was no significance between the survival rate of four joints of elbow, carpal, knee and ankle joint. 6-20 months follow-up visitting revealed obvious improvement of the function of the joints and the appearance and tenacity was closed to the normal skin. Conclusion Composit skin graftting is a good therapy in the contracted scar plasty surgery of limb＇ s joint,which can get a good appearance and tenacity and improved function of joints.