双层人工真皮修复跟腱止点外露创面

Double-layer artificial dermis for repair of the wound with exposed Achilles tendon insertion

[目的]观察双层人工真皮修复跟腱止点外露创面的临床疗效。[方法]2015年4月—2020年8月,对7例合并跟腱止点外露的皮肤软组织缺损的病例,一期予以清创、VSD处理,待创面新鲜干净后,二期应用双层人工真皮覆盖修复。术后2~3 d打开纱布观察皮片下情况,之后每3~4 d换药1次。术后2~3周,粉红色的类真皮组织覆盖外露的骨质及跟腱,通过定期换药,创面自然上皮化。[结果]本组7例患者创面经自然上皮化后完全愈合,创面自然上皮化的时间为18~34 d。均未行自体皮片移植。术后随访6~18个月,修复后的创面皮肤外形饱满有弹性,无明显瘢痕挛缩及色素沉着,质地耐磨无破溃。末次随访时,AOFAS评分为(90.6±4.6)分,VSS评分为(5.1±1.8)分。[结论]应用双层人工真皮修复跟腱止点外露创面,手术操作简单,损伤小,疗效确切。

[Objective]To observe the clinical effect of double-layer artificial dermis in repairing wound with exposed Achilles tendon insertion.[Methods]From April 2015 to August 2020,7 patients received debridement and VSD in the first stage for wound with exposed Achilles tendon insertion,and then had the wound covered with double layer artificial dermis in the second stage as the wounds became fresh and clean.Open the gauze 2~3 days after surgery to observe the wound conditions,and then change the dressing every 3~4 days.Two to three weeks after surgery,pink dermal tissue covered the exposed bone and Achilles tendon,and the wound was naturally epithelialized by regular dressing changes.[Results]All the wounds in the 7 patients completely healed after natural epithelialization in 18~34 days,and no autologous skin grafting was performed in anyone of them.After 6~18 months of follow-up,the repaired wound skin was full and elastic,without obvious scar contracture and pigmentation,and wear-resistant texture without rupture.At the last follow-up,the AOFAS score was(90.6±4.6)and the VSS score was(5.1±1.8).[Conclusion]The application of double-layer artificial dermis is simple,less damaging and effective to repair the wound with exposed Achilles tendon insertion.