脱细胞异体真皮与自体刃厚皮片联合移植修复足踝部非负重区创面的临床研究

Clinical research of co-transplantation of acellular allogeneic dermis and autologous razor-thin skin for repairing wound in non-weight-bearing area of foot and ankle

目的探讨脱细胞异体真皮与自体刃厚皮片联合移植在足踝部非负重区创面修复中的疗效。方法采用回顾性队列研究方法,分析2015年1月至2021年3月上海交通大学医学院附属第六人民医院收治的51例足踝部非负重区创面患者。按照治疗方式不同进行分组,行复合皮移植治疗患者24例,设为复合皮移植组;采用自体全厚皮片移植治疗患者27例设为全厚皮移植组。患者创面清创后,复合皮移植组用脱细胞异体真皮覆盖创面,其上覆盖自体刃厚皮片联合移植,全厚皮移植组使用自体全厚皮片覆盖创面。术后评估2组患者的皮片成活率、再植皮率、创面愈合时间以及供皮区愈合时间。术后随访12个月,末次随访时进行美国足踝外科医师协会(AOFAS)踝关节功能评估及温哥华瘢痕量表(VSS)评分。数据比较采用t检验、Wilcoxon检验、卡方检验及Fisher精确检验。结果术后评估,复合皮移植组和全厚皮移植组的皮片最终均存活。全厚皮移植组因术后皮片部分坏死的再植皮率为22.2%(6/27),高于复合皮移植组的4.2%(1/24),但差异无统计学意义(P=0.103)。复合皮移植组创面愈合时间为17.0(15.8,18.0)d,显著短于全厚皮移植组的24.0(18.0,38.0)d,差异有统计学意义(Z=-4.222,P<0.01)。2组患者供区愈合时间差异无统计学意义(P>0.05)。复合皮移植组的AOFAS踝关节功能评分为93.0(92.0,95.0)分,显著优于全厚皮移植组的87.0(84.0,91.5)分,差异有统计学意义(Z=3.574,P<0.01)。复合皮移植组VSS评分为5.0(4.0,6.0)分,优于全厚皮移植组7.0(5.5,8.5)分,差异有统计学意义(Z=-3.823,P<0.01)。结论脱细胞异体真皮与自体刃厚皮片联合移植可有效修复足踝部非负重区皮肤软组织缺损,显著促进创面愈合,术后瘢痕较轻且可保持良好的踝关节功能。

Objective To explore the clinical effect of co-transplantation of the acellular allogeneic dermis and autologous razor-thin skin for repairing wounds in the non-weight-bearing area of the foot and ankle.Methods A retrospective cohort study was performed.From January 2015 to March 2021,51 patients with skin and soft tissue defects in the non-weight-bearing area of the foot and ankle were admitted to the Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine.Patients were grouped according to different treatment methods.24 patients who received composite skin transplantation were designated as the co-transplantation group,and 27 patients who received autologous full-thickness skin grafting were designated as the full-thickness skin transplantation group.After debridement of the wound,the co-transplantation group was covered with the acellular allogeneic dermis,which was covered with autologous razor-thin skin grafts for combined transplantation,and the full-thickness skin graft group was covered with autologous full-thickness skin grafts.The survival rate of grafts,wound healing time,donor site healing time,and wound regrafting rate were evaluated postoperatively in both groups.The postoperative follow-up was 12 months,and AOFAS ankle function evaluation and vancouver scar scale(VSS)were performed at the last follow-up.Data were compared using the t-test,Wilcoxon test,chi-square test and Fisher′s exact test.Results The postoperative evaluation showed that all the transplantations in the two groups survived.The regrafting rate due to partial necrosis of the skin graft in the full-thickness skin transplantation group(22.2%,6/27)was higher than that in the co-transplantation group(4.2%,1/24)but no statistically significant difference(P=0.103).The wound healing time in the co-transplantation group was 17.0(15.8,18.0)d,which was significantly shorter than that in the full-thickness skin transplantation group,which was 24.0(18.0,38.0)d,and the difference was statistically significant(Z=-4.222,P<0.01).There was no significant difference in the healing time of the donor site between the two groups(P>0.05).The AOFAS ankle function score of the co-transplantation group was 93.0(92.0,95.0)points,which was significantly better than that of the full-thickness skin graft group,which was 87.0(84.0,91.5)points(Z=3.574,P<0.01).The VSS score of the co-transplantation group was 5.0(4.0,6.0)points,which was better than that of the full-thickness skin transplantation group,which was 7.0(5.5,8.5)points,and the difference was statistically significant(Z=-3.823,P<0.01).Conclusions The co-transplantation of the acellular allogeneic dermis and autologous razor-thin skin graft can effectively repair the wound in the non-weight-bearing area of the foot and ankle,significantly reduce the postoperative scarring,preserve good ankle function after surgery,and promote wound healing.