人工真皮在急诊手外伤中的应用

Clinical application of artificial dermis in emergency hand trauma

目的根据临床病例随访研究及查阅相关文献总结双层人工真皮对于手外伤的治疗效果及意义。方法2019年10月-2020年12月,对12例手部缺损患者采用双层人工真皮修复,彻底清创后,应用人工真皮覆盖创面,沙包加压包扎,术后抗感染、止痛,2~3周后拆除纱包,视情况拆除人工真皮硅胶层,观察创面愈合情况、血运、外观、瘢痕情况、感觉和功能。结果术后1个月,2例缺损严重者较正常皮肤平整度稍欠佳,略低于周围组织(<0.5 mm),其他病例愈合平整,无明显瘢痕,功能活动恢复良好,但感觉恢复欠佳。术后2个月,植皮区外观恢复满意,颜色与正常皮肤接近,无明显色素沉着及瘢痕。术后4个月,植皮区肤色与正常皮肤无明显差别,部分感觉恢复,患者满意。结论人工真皮在急诊修复手部较小范围皮肤缺损中有着非常重要的地位,手术操作简单,疗效确切,可使真皮样组织生长至基质层,并在暴露的骨和肌腱上血管化,为重建手术提供强有力的选择,创面愈合后外形及功能满意,现已成为急诊手外伤治疗的供选方法之一。

Objective To summarize the therapeutic effect and significance of double-layer artificial dermis for hand injury based on Clinical Case follow-up study and literature review.Methods From October 2019 to December 2020,12 cases of hand defect were repaired with domestic double-layer artificial dermis.After thorough debridement,artificial dermis was used to cover the wound surface,gauze bag was used to compress the wound,and anti-infection and analgesis were applied after operation,after 2-3 weeks,the gauze bag was removed and the silicone layer of artificial dermis was removed as appropriate.The wound healing,blood circulation,appearance,scar,sensation and function were observed.Results One month after operation,2 cases with serious defect were slightly less smooth than normal skin,slightly lower than the surrounding tissue(less than 0.5 mm),other cases healed smoothly without obvious scar,functional activity recovered well,but feeling was slightly poor.2 months after operation,the appearance of skin graft area was satisfactory,the color was close to normal skin,no pigmentation and keloid.4 months after operation,the skin color of the skin graft area was not different from that of normal skin.Conclusion Artificial dermis plays an important role in emergency repair of small skin defect of hand.The operation is simple and effective.It can make the dermis-like tissue grow to the stroma and vascularize the exposed bone and tendon,it provides a powerful choice for reconstructive surgery,and the appearance and function of the wound are satisfactory after healing.