应用人工真皮和自体皮移植修复难愈性创面

Repair non-healing wound with artificial dermis and autologous skin graft

目的了解人工真皮联合自体皮移植修复难愈性创面的可行性并评价其治疗效果。方法选择20例住院患者共25处持续8周以上的难愈性创面，分为慢性溃疡组9例11处创面，为创伤、烧伤后瘢痕溃疡创面；骨外露组11例14处创面，骨外露面积为0.8-77.0cm。（最大面积为22.0cm×3.5cm）。手术方法为I期扩创移植人工真皮，2-6周后局部血管化良好，外露肌腱和骨质被类真皮组织覆盖，Ⅱ期移植自体薄断层皮片。结果慢性溃疡组9例患者的11处创面中，9处愈合优良，2处经换药后愈合。骨外露组11例患者的14处创面中，12处愈合优，外露骨质得到有效覆盖；2处创面因感染人工真皮未成活，随后行皮瓣修复手术。随访5-24个月，未见创面复发，外观满意，无明显增生性瘢痕，供皮区亦无明显瘢痕形成。结论人工真皮联合自体皮移植修复难愈性创面，方法简便、创面愈合质量高、供皮区损失轻微，为难愈性创面的修复提供了新的选择。

Objective To observe the feasibility of repairing non-healing wound with artificial dermis and autologous skin graft, and to evaluate its efficacy. Methods Twenty in-patients with 25 non-healing wounds lasting more than 8 weeks were divided into chronic ulcer group （9 patients with 11 ulcerating scars after trauma and burn） , and bone exposing group （11 patients with 14 wounds with exposed bone ranging from 0.8-77.0 cm^2 in size, the largest 22.0 cm×3.5 cm）. Wounds were debrided and repaired with artificial dermis in the first stage. Autologous split-thickness skin was grafted in the Ⅱ stage when the wounds were well vascularized locally and exposed bone and tendon were covered with dermis-like tissue within 2-6 weeks. Results In chronic ulcer group, 9 of the 11 wounds healed well, the other 2 healed after routine dressing change. In bone exposing group, 12 of the 14 wounds healed well and the exposed bone was effectively covered; artificial dermis on the other 2 wounds failed to survive due to infection, and they were repaired with skin flap later. Patients were followed up for 5-24 months. Wounds healed with satisfactory appearance and no recurrence of wound or obvious hyperplasic scar was observed ; no obvious scar was observed in the donor site. Conclusions The method of repairing non-healing wound with artificial dermis combining with autologous skin graft is simple ; and it results in healing of wounds with high quality and little damage to the donor site. It provides a new choice for repairing non-healing wound.