双层人工真皮修复指端缺损并骨外露

Double-layer artificial dermis for repair of finger tip defect complicated with bone exposed

[目的]探讨Lando^(■)双层人工真皮修复材料修复指端缺损伴指骨外露创面的临床疗效。[方法]2020年1月—2022年12月作者对30例(30指)因各种外伤导致手部指端缺损合并指骨外露患者行清创后,采用双层人工真皮缝合于缺损处,打包加压包扎。术后7~10 d拆除加压缝合包,术后3周拆除缝线,术后4周揭除双层人工真皮表面硅胶膜,让创面自然上皮化。观察创面愈合外观及功能恢复,评估疗效。[结果]30例患者中,27例创面均一期愈合;2例患者部分创面残留,但无骨外露,换药后愈合;1例患者术后仍部分肌腱外露,再次行双层人工真皮移植修复后愈合。所有创面自然上皮化时间平均为(60.1±8.8)d。术后随访均超过6个月,创面愈后指腹饱满,色泽良好,皮肤感觉良好。与术后3个月相比,术后6个月两点辨别觉显著改善[(3.8±1.1)mm,(2.5±0.9)mm,P<0.001]。[结论]双层人工真皮一期修复指端合并骨外露缺损创面操作简单,供区损伤小,疗效可靠。

[Objective]To investigate the clinical efficacy of Lando^(■)double-layer artificial dermis used for repair of finger tip defectcomplicated with bone exposed.[Methods]From January 2020 to December 2022,30 patients(30 fingers)had double-layer artificial der-mis with pressure dressing used after debridement to repair the finger tip defect complicated with bone exposed.The compression suture kitwas removed 7~10 days after surgery,the sutures were removed 3 weeks after surgery,while the surface silicone film over double layer arti-ficial dermis was removed 4 weeks after surgery to allow the wound to be naturally epithelialized.The appearance of wound healing andfunctional recovery were observed,and the curative effect was evaluated.[Results]Of the 30 patients,27 patients got wound healing in onestage,2 patients had a part of the wound remained without bone exposure,and got wound healed after dressing change,whereas one patientremained a part of the tendon exposure after surgery,and had the tendon healed after revision double-layer artificial dermis implantation.All the patients were followed up for more than 6 months,with the mean time of natural epithelialization of(60.1±8.8)days.After the woundhealed,the finger belly was well-stacked with good color and proper skin sensation.Compared with that 3 months after surgery,the averagetwo-point discrimination was significantly improved at 6 months after surgery[(3.8±1.1)mm,(2.5±0.9)mm,P<0.001].[Conclusion]Thisdouble-layer artificial dermis used to repair of finger tip defect with bone exposed in one stage is simple and effective technique without do-nor area damage.