人工真皮在骨、肌腱外露创面中的应用

Application of artificial dermis in wound with bone and/or tendon exposure

目的评价人工真皮应用于骨、肌腱外露创面中的可行性及真实效果。方法选取2010年11月至2014年11月我院骨科应用皮能快愈敷料治疗的外伤后骨、肌腱外露创面患者23例,先进行人工真皮植入,再按常规创面进行自体游离植皮修复。一期清创,移植人工真皮(坏死多污染大的创面先行VSD封闭负压吸引,后再移植人工真皮),2~3周外露的骨、肌腱被类真皮组织生长覆盖后,再行二期移植自体游离皮片手术。结果 22例得到3~14个月的随访,1例失访;21例类真皮组织生长良好,骨、肌腱外露处均得到良好覆盖,植皮存活,植皮颜色稍深,弹性好,无慢性溃疡,其周围关节活动功能保持良好,供皮区未见瘢痕形成。1例掌指挫裂伤者指背骨关节及伸指肌腱外露,行一期清创及皮能快愈敷料植入。术后掌背创面愈合良好;手指创面出现创缘皮肤进一步坏死感染,最终行皮瓣移植修复。结论人工真皮应用于骨、肌腱外露创面简便可靠,其不但能有效消除骨、肌腱外露创面,而且保持局部皮肤弹性,能较好地保存小关节活动功能及肌腱滑动功能,是骨、肌腱外露创面修复的较好的选择手段。

Objective To analyze and evaluate the feasibility and clinical effect of repairing wound with bone and/or tendon exposure with artificial dermis. Methods Twenty-three in-patients with wound with bone and/or tendon exposure in Department of Orthopedics in our hospital from Nov. 2010 to Nov. 2014 were selected. The wound was repaired with artificial dermis and then autologous skin sequentially. Artificial dermis was implanted after debridement in the first stage(In the patients with serious necrosis or pollution, vacuum sealing drainage(VSD) was used in prior). Autologous free skin graft was transplanted in the second stage of 2 to 3 weeks later, when the wound with bone and/or tendon exposure was covered with dermis like tissue. Results Twenty-two had a follow-up of 3~14 months and one lost.The wound in 21 cases were well covered with dermis like tissue, and all autologous free skin graft survived, with a little deep colour, good elasticity, good joint function and no chronic ulcer. In the one case of dorsal metacarpophalangeal contusion and laceration with bone and joint and extensor tendons exposure, artificial dermis were used after debridement in the first stage and then autologous skin was transplanted in the second stage routinely. The wound was healing well in the dorsal metacarpal, but there were failure with further necrosis and infection in the dorsal digital wounds, needing skin flaps transplantation finally. Conclusion It is a good choice to repair wound with bone and/or tendon exposure with artificial dermis for it’s simplicity and reliability. It can not only eliminate the wound, but can also retain good skin elasticity for joint motion and tendon gliding functions.