儿童手部掌侧皮肤缺损全厚皮片移植术供区优化选择

Optimal selection of donor site for full-thickness skin graft in pediatric palmar hand skin defect

目的探讨腹股沟区、手腕尺侧及足底内侧作为修复儿童手部掌侧皮肤缺损全厚皮片供区的优化选择。方法回顾性分析2017年12月至2018年12月, 于重庆医科大学附属儿童医院烧伤整形外科行手部全厚皮片移植术, 术后皮片完全存活且有半年以上随访的手部掌侧皮肤缺损患儿的临床资料。根据全厚皮片供区分为腹股沟区、手腕尺侧和足底内侧3个组。采用潘通皮肤色卡指南测定受区移植全厚皮片与周围皮肤色差;采用患者与观察者瘢痕评估量表对受、供区术后瘢痕进行评分;评估受、供区的术后效果家长满意度。计量资料采用Kruskal-Wallis秩和检验、Mann-WhitneyU检验, 计数资料采用Fisher’s精确概率检验, P<0.05为差异有统计学意义。结果共纳入68例患儿, 男44例, 女24例, 年龄(3.19±2.74)岁(6个月至14岁), 其中腹股沟区供皮37例, 手腕尺侧供皮19例, 足底内侧供皮12例。术后随访(14.07±2.94)个月(7~18个月)。3组不同供皮区的术后受区移植皮片色差及家长满意度比较, 差异均具有统计学意义(P<0.01), 其中足底内侧组、手腕尺侧组色差均小, 腹股沟区组色差最大;足底内侧供皮组家长满意度最佳, 其次为手腕尺侧供皮组, 腹股沟区供皮组家长满意度最差。3组术后受、供区瘢痕的评估差异均无统计学意义(P>0.05)。3组患儿术后受区家长满意度评级中, 足底内侧组级别为优者比例最高, 其次为手腕尺侧组, 腹股沟区组最低, 3组间比较差异有统计学意义(P<0.01)。结论采用全厚皮片移植修复儿童手部掌侧皮肤缺损时, 为获得最佳的重建效果, 缺损面积不大时, 偏掌侧的缺损推荐足底内侧供皮, 偏手指侧方的缺损以手腕尺侧供皮为宜。

Objective This study aims at exploring the groin area,the ulnar side of the wrist,and the medial plantar side as a more optimal donor area for repairing children’s hand volar skin defects.Methods From December 2017 to December 2018,clinical data of children with palmar skin defects of hands who underwent full-thickness skin grafting in the Department of Burn and Plastic Surgery,Children’s Hospital Affiliated to Chongqing Medical University,were retrospectively analyzed.All skin grafts survived utterly.According to the donor site of full-thickness skin graft,the children were divided into three groups:the groin,ulnar wrist,and medial plantar skin donor group.The PANTONE skin tone guide measured the color difference between the full-thickness skin graft and the surrounding skin.The postoperative scars of the recipient and donor areas were scored by the Patient and Observer Scar Assessment Scale.Meanwhile,the postoperative effect and parents’satisfaction with recipient and donor areas were evaluated.Kruskal Wallis rank-sum test and Mann Whitney U test were used for measurement data.Fisher’s exact test was used for counting data.A P-value<0.05 was considered significant.Results A total of 68 children were enrolled,including 44 males and 24 females.The mean age was(3.19±2.74)years(ranging from 6 months to 14 years).Among them,37 children’s palmar skin defects were reconstructed by full-thickness skin grafts from the inguinal region,19 from the ulnar side of the wrist,and 12 from the medial side of the plantar.The final follow-up time was from 7 months to 18 months,with an average of(14.07±2.94)months.There were significant differences among the three groups in the pigmentation of skin grafts and parents’satisfaction(P<0.01).The color difference of medial plantar skin donor group and ulnar wrist skin donor group was small,and the groin skin donor group had the most obvious color difference of skin graft.The satisfaction of parents in the medial plantar skin donor group was the best,followed by the ulnar wrist skin donor group,and the groin skin donor group had the worst satisfaction of parents.There was no significant difference in scar evaluation in recipient and donor areas among the three groups(P>0.05).Among the parents’satisfaction ratings in the receiving area of the three groups,the medial plantar group had the highest proportion of excellent,followed by the ulnar wrist group and the groin group.There were significant differences among the three groups(P<0.01).Conclusions The full-thickness skin graft harvested from the medial plantar and ulnar side of the wrist are better choices for small or medium-sized palmar skin defects in children than the inguinal area with superior aesthetics.The medial plantar area is recommended as a donor site for the palmer skin defects in hands,choosing the ulnar aspect of the wrist is more appropriate for the defects in the lateral fingers.