人工真皮复合全厚皮修复儿童足踝部皮肤软组织缺损

Repair of foot and ankle skin defects in children with artificial dermis and fall-thickness skin graft

目的研究并评价儿童足踝部皮肤软组组缺损伴软骨或骨外露使用人工真皮（Pelnac）联合自体全厚皮移植的治疗效果。方法回顾分析2011年1月至2013年2月间收治的13例足踝部皮肤软组织缺损伴骨或软骨外露患儿，男9例，女4例，年龄3～9岁，平均5．2岁。软组织缺损面积12~62cm2，平均35．5cm2，骨或软骨外露面积0．7～6．0cm2，平均3．0cm2。一期清创行VSD覆盖，二期采用Pelnac覆盖创面，2～3周后在Pelnac表面移植自体全厚皮肤修复创面。结果所有患儿所植皮肤全部存活，创面得到了有效的修复。移植皮肤未见瘢痕增生挛缩，无明显色素沉着，足踝部外观恢复满意，下肢负重、行走功能正常。供区仅遗留线性瘢痕，部位隐蔽不易察觉。结论对于足踝部皮肤软组织缺损伴骨或软骨外露的儿童患者，采用Pelnac结合自体腹部全厚皮复合移植可取的满意效果。避免了传统皮瓣移植手术所致的供区损伤大、皮瓣外观欠佳等缺点。

Objective To evaluate the clinical outcomes of artificial dermis（Pelnac） combined with full-thickness skin graft in treating skin and soft tissue defects of foot and ankle in children. Methods From January 2011 to Feburary 2013, 13 children （9 boys, 4 girls） underwent transplantation of artificial dermis with full-thinkness abdomen or groin skin were retrospectively reviewed. The average age was 5.2 years old, ranged from 3 to 9 years. All of the soft tissue defects were caused by trauma. The area of skin and soft tissue defects ranged from 12 cm2 to 62 cm2. The area of bone or cartilage exposure ranged from 0. 7 cm2 to 6. 0 cm2. Initial debridement and vacuum sealing drainage（VSD） coverage were followed by Pelnac covering if the wounds did not infected after several days Full-thickness abdomen or groin skin was transplanted and the exposed bone or cartilage was covered by dermis-like tissues when the local granulation tissue grew well 2-3 weeks later. Results All cases had good coverage of the wounds and grafts survival. One case had skin defects about 0. 5 cm - 0. 5 cm on the surface of cartilage, and the defect was covered only by dressing. All the cases were followed up from 4 months to 14 months. The appearance of the recipient site is good without obvious scar in all cases. The donor skin heals well with linear scar. Conclusions Artificial dermis combined with full thickness skin graft is effective to repair skin and soft tissue defects associated with bone or cartilage exposure of foot and ankle. It can also avoid the poor appearance of the conventional flap and the large injury to the donor site.