皮耐克人工真皮修复儿童甲母痣切除后软组织缺损的临床应用

Clinical application of artificial dermis Pelnac in repairing the soft tissue defect after the nail matrix nevus excision in children

目的探讨应用皮耐克人工真皮修复儿童甲母痣切除后软组织缺损的临床效果。方法回顾分析2017年2月至2018年9月收治的甲母痣患儿共18例,平均甲板黑线宽度5.33 mm。手术方式为拔除甲板,暴露病变,切除包含病变的全部甲单元,注意保留指(趾)骨骨膜,将皮耐克人工真皮覆盖裸露指(趾)骨,修复软组织缺损。术后随访,评估临床疗效。结果所有患儿均获随访,平均31.28个月。病理检查结果:交界痣14例,复合痣4例。切除后创面面积0.48~2.40 cm^(2),平均1.17 cm^(2)。平均手术时间约40 min,术后3周左右开始出现自然上皮化,6~8周完全上皮化。术后根据中华医学会手外科学会上肢部分功能评定试用标准进行感觉评分:16例S4,2例S3+;温哥华瘢痕量表(VSS)评分平均1.33;视觉模拟评分法(VAS)评分0分。结论应用皮耐克人工真皮修复儿童甲母痣切除后的软组织缺损,修复技术简单,手术时间短,风险小,不会造成新的副损伤及瘢痕,临床疗效良好。

Objective To explore the clinical effect of artificial dermis Pelnac in repairing the soft tissue defect after the nail matrix nevus excision in children.Methods A total of 18 children with nail matrix nevus admitted from February 2017 to September 2018 were retrospectively analyzed.The average width of longitudinal melanonychia was 5.33 mm.The surgical procedures included removing the nail plat to expose the lesion,excising the whole nail unit including the lesion,periosteum was reserved.The artificial dermis Pelnac was implanted on the bare phalanx to repair soft tissue defects.Postoperative follow-up was conducted to evaluate the clinical efficacy.Results All the children were followed up for an average of 31.28 months.The pathological results of 18 cases were as follows:junction nevus in 14 cases and compound nevus in 4 cases.The wound area after resection was 0.48-2.40 cm^(2) with an average of 1.17 cm^(2).The average operation time was about 40 minutes,natural epithelialization began about 3 weeks after surgery,and complete epithelialization occurred 6-8 weeks after surgery.Postoperatively,sensory score was made according to the trial standard of upper limb function assessment of Hand Surgery Society of Chinese Medical Association:16 cases of S4 and 2 cases of S3+.The average Vancouver Scar Scale(VSS)score was 1.33 and the Visual Analogue Scale(VAS)score was 0.Conclusion The technique of repairing the soft tissue defect after the nail matrix nevus excision in children by using artificial dermis Pelnac is simple,short in time,low in risk,and will not cause new collateral damage or scar.It has a good clinical effect and is suitable for children's surgery.