人工真皮结合刃厚皮片移植在复杂性手外伤创面闭合中的应用

Application of Artificial Dermis Combined with Split-Thickness Skin Grafting in Closure of Complex Wound of Hand Injury

目的 探讨人工真皮早期创面覆盖结合二期刃厚皮片移植在复杂性手外伤术后创面闭合中应用的可行性及临床疗效。方法 回顾分析2018年6月至2020年5月我院手足外科收治的31例复杂性手外伤并皮肤缺损合并创面骨质或肌腱外露患者的临床资料。患者均急诊行清创、固定骨折、一期修复肌腱及血管神经,修复后皮肤缺损创面覆盖人工真皮,待胶原层完全血管化后二期行刃厚皮片游离移植。观察人工真皮覆盖后创面真皮组织生长及皮片移植成活情况。结果 本组31例创面大部分胶原层血管化良好,肌腱及骨质表面真皮组织生长良好,2例创面边缘少部分肌腱裸露,经刃厚皮片移植后均顺利成活。所有患者均获随访,随访时间6~12个月,创面植皮均成活良好,皮肤质地、外观良好,无明显色素沉着,无破溃,肌腱粘连轻微,瘢痕增生不明显,术后手部功能恢复良好。结论 人工真皮可明显促进复杂性手外伤特别是骨及肌腱裸露创面的组织生长,结合刃厚皮片移植,可有效避免外露骨及肌腱坏死,避免行游离皮瓣移植等复杂手术,后期创面外观及肢体功能恢复较好,适合推广。

Objective To explore the feasibility and clinical efficacy of early artificial dermis wound covering combined with second-stage split-thickness skin grafting in the treatment of complex residual wounds of hand injury. Methods The clinical data of 31 patients with complex hand injury and skin defect combined with bone or tendon exposure admitted to our hospital from June 2018 to May 2020 were analyzed retrospectively. All patients underwent emergency debridement, fracture fixation, primary repair of tendon, vascular and nerve, skin defect wound covered with artificial dermis and free split-thickness skin grafting after complete vascularization of collagen layer in the second stage. The growth of dermal tissue and the survival of skin grafting were observed after the artificial dermis covered. Results Most of the collagen layer of wound surface vascularized well and the dermal tissue of the tendon and bone surface grew well in all 31 cases. There was a small part of the tendon exposed at the edge of the wound in 2 cases, and survived after split-thickness skin slices grafted. All cases were followed up for 6 to 12 months, and all grafting skins survived well without rupture. The skin grafts had good texture and appearance, slight tendon adhesion, inapparent hypertrophic scar and good function without obvious pigmentation. Conclusions Artificial dermis can significantly promote the tissue growth of complex wound of hand injuries, especially for the wounds with exposed bone and tendon. Combined with split-thickness skin grafting, it can avoid the necrosis of exposed bone and tendon, avert complex surgery of free skin flap grafting, and achieve good appearance of wound and limb function recovery, which is suitable for generalization.