Reconstruction of massive skin avulsion of the scrota and penis by combined application of dermal regeneration template(Pelnac) and split-thickness skin graft with vacuum-assisted closure: A case report

BACKGROUND Although skin avulsions to male external genitalia are rare, they can be both physically and psychologically traumatic. Thus, the necessity for judicious management poses significant challenges to surgeons in order to avoid potential permanent disabilities. We report a case of massive penoscrotal skin avulsion and a composite graft was creatively applied to cover the defect which achieved good results. We believe that this case is of great reference value for fellow surgeons.CASE SUMMARY A 52-year-old male presented with massive traumatic avulsion of the penile and scrotal skin following mishandling of an electric drill. The avulsed skin was missing. The patient was diagnosed with massive skin avulsion of external genitalia. Following initial complete debridement of devitalized or infected tissues, Pelnac dermal substitute was secured to the defect with the assistance of negative-pressure wound closure. In the final step, the silicone layer of Pelnac was removed and a split-thickness skin graft was applied. The defect had healed at the two-month follow-up. The patient now has normal erections and satisfactory sexual function.CONCLUSION Our experience with this wound repair demonstrated that the combination of a dermal regeneration template and a split-thickness skin graft with vacuumassisted closure is a safe, well-tolerated and efficient solution for the reconstruction of massive penoscrotal skin defects.

A Prospective, Within-Patient Controlled Study to Compare the Ability of the Non Adherent Drawtex®Hydroconductive Dressing to a Transparent Polyurethane Film Dressing (Standard of Care) on the Healing of Split-Thickness Skin Graft Donor Sites

Background: Dressing of split-thickness skin graft donor sites can be traumatic for the patient. The most advanced and expensive dressings have been compared to the most basic of dressings, with little or no consensus and an unpersuasive level of evidence. We aimed to determine the efficacy of the locally manufactured non-adherent, hydroconductive Drawtex? dressing and compare it to our current standard-of-care dressing, a thin transparent polyurethane film, in the healing of split-thickness donor sites. Methods: This prospective, within-patient controlled study included 27 adult participants, each with two split-thickness skin donor sites. The 54 donor site wounds were compared with regard to time to re-epithelialisation, perceived pain and healed wound quality. Results: By day 5, complete healing of donor site wounds, defined as >90% of epithelialized surface, was significantly higher in the hydroconductive dressing group compared to the polyurethane film group (22.2% and 3.7%, respectively;p < 0.0001). The hydroconductive dressing-treated donor site wounds were significantly less painful at 24-hours, 48-hours and 7-days post-operatively, and had fewer complications and superior wound healing quality. Conclusion: We have demonstrated that the relatively cheap and readily available dressing made locally in South Africa, Drawtex? is at least as safe, and potentially superior in wound healing, when compared to our current standard-of-care dressing.

Histologic analysis and long-term effect of acellular dermal matrix combined with autologous thin split-thickness skin graft

Objective To evaluate the long-term therapeutic effect and histologic result of ADM combined with autologous thin split-thickness skin graft.Methods 23 patients were treated with acellalar dermal matrix(ADM) combined with autoiogous

One-step approach for full-thickness skin defect reconstruction in rats using minced split-thickness skin grafts with Pelnac overlay

Background:Split-thickness skin grafting is the current gold standard for the treatment of traumatic skin loss.However,for patients with extensive burns,split-thickness skin grafting is limited by donor skin availability.Grafting split-thickness skin minced into micrografts increases the expansion ratio but may reduce wound repair quality.Dermal substitutes such as Pelnac can enhance the healing of full-thickness skin wounds,but their application currently requires two surgeries.The present study investigated whether it is possible to repair full-thickness skin defects and improve wound healing quality in a single surgery using Pelnac as an overlay of minced split-thickness skin grafts in a rat model.Methods:A full-thickness skin defect model was established using male Sprague-Dawley rats of 10 weeks old.The animals were randomly divided into control and experimental groups in which Vaseline gauze and Pelnac,respectively,were overlaid on minced split-thickness skin grafts to repair the defects.Wound healing rate and quality were compared between the two groups.For better illustration of the quality of wound healing,some results were compared with those obtained for normal skin of rats.Results:We found that using Pelnac as an overlay for minced split-thickness skin grafts accelerated wound closure and stimulated cell proliferation and tissue angiogenesis.In addition,this approach enhanced collagen synthesis and increased the formation of basement membrane and dermis as well as the expression of growth factors related to wound healing while reducing scar formation.Conclusions:Using minced split-thickness skin grafts overlaid with Pelnac enables the reconstruction of fullthickness skin defects in a single step and can increase the healing rate while improving the quality of wound healing.

不同人工真皮结合自体刃厚皮片移植修复骨质肌腱外露创面的疗效对比

目的:对比不同人工真皮结合自体刃厚皮片移植修复骨质肌腱外露创面的临床及美学效果。方法:回顾性分析2019年5月-2022年5月在笔者医院进行创面修复治疗的60例骨质肌腱外露创面患者临床资料,根据患者手术方式不同,将采用皮能快愈双层人工真皮结合自体刃厚皮片移植修复者纳入对照组(n=37),将采用国产双层人工真皮结合自体刃厚皮片移植修复者纳入研究组(n=23)。对比两种修复方式移植效果及皮片成活情况。结果:两组植皮次数、并发症发生率及皮片成活率比较比较差异无统计学意义(P>0.05),研究组移植间隔时间长于对照组(P<0.05);两组在治疗后3、7、14 d的白细胞介素-1、肿瘤坏死因子、白细胞介素-12、γ干扰素水平比较差异均无统计学意义(P>0.05);两组治疗后3 d的转化生长因子β1、血管内皮生长因子水平比较差异均无统计学意义(P>0.05),但研究组治疗后7、14 d的转化生长因子β1、血管内皮生长因子均低于对照组(P<0.05);治疗后3个月,两组温哥华瘢痕量表评分比较差异无统计学意义(P>0.05)。结论:在骨质肌腱外露创面修复治疗中,国产双层人工真皮结合自体刃厚皮片与皮能快愈双层人工真皮结合自体刃厚皮片移植效果相当,但存在移植时间间隔较长的弊端,可能与创面组织生长因子水平略低有关。

Prospective randomised controlled trial of Algisite^(TM) M, Cuticerin^(TM), and Sorbact■ as donor site dressings in paediatric split-thickness skin grafts

Background:This is a parallel three-arm prospective randomised controlled trial (RCT) comparing Algisite?M, Cuticerin?, and Sorbact? as donor site dressings in paediatric split-thickness skin grafts (STSG). All three were in current use within the Pegg Leditschke Children's Burn centre (PLCBC), the largest paediatric burns centre in Queensland, Australia. Our objective was to find the best performing dressing, following on from previous trials designed to rationalise dressings for the burn wound itself. Methods:All children for STSG, with thigh donor sites, were considered for enrolment in the trial. Primary outcome measures were days to re-epithelialisation, and pain. Secondary measures were cost, itch, and scarring at 3 and 6 months. Patients and parents were blinded to group assignment. Blinding of assessors was possible with the dressing in situ, with partial blinding following first dressing change. Blinded photographic assessments of re-epithelialisation were used. Scar assessment was blinded. Covariates for analysis were sex, age, and graft thickness (as measured from a central biopsy). Results:There were 101 patients randomised to the Algisite?M (33), Cuticerin?(32), and Sorbact? (36) arms between April 2015 and July 2016. All were analysed for time to re-epithelialisation. Pain scores were not available for all time points in all patients. There were no significant differences between the three arms regarding pain, or time to re-epithelialisation. There were no significant differences for the secondary outcomes of itch, scarring, or cost. Regression analyses demonstrated faster re-epithelialisation in younger patients and decreased donor site scarring at 3 and 6 months with thinner STSG. There were no adverse effects noted. Conclusions:There are no data supporting a preference for one trial dressing over the others, in donor site wounds (DSW) in children. Thinner skin grafts lead to less donor site scarring in children. Younger patients have faster donor site wound healing. Trial registration:Australia and New Zealand Clinical Trials Register (ACTRN12614000380695). Royal Children's Hospital Human Research Ethics Committee (HREC/14/QRCH/36). University of Queensland Medical Research Ethics Committee (#2014000447).

脱细胞异体真皮与自体表皮复合移植修复创面

目的 研究应用脱细胞异体真皮与自体表皮复合移植修复创面的临床效果。 方法 2 0 0 0年 7月～2 0 0 2年 8月 ,应用脱细胞异体真皮与自体表皮构成的复合皮对 34例头颈、躯干及四肢等部位的创面进行修复 ,创面最小5 cm× 10 cm,最大 12 cm× 19cm,其中陈旧性肉芽创面 2例 ,巨大色素痣切除创面 4例 ,皮肤广泛毛细血管瘤切除后创面 6例 ,瘢痕切除后创面 2 2例。观察移植皮片的成活率及愈后皮片色泽、功能情况。 结果 临床应用 34例 ,术后移植复合皮全部成活 ,30例获 3个月～ 2年随访 ,移植皮片颜色与周围正常肤色接近 ,皮片柔软 ,瘢痕增生不明显 ,功能改善显著。 结论 脱细胞异体真皮与自体表皮复合移植较单纯自体表皮移植后 ,皮片质量及关节部位功能上均有明显改善 ,尤其适合于四肢创面修复。

先天性小耳畸形的耳廓再造

目的探讨先天性小耳畸形的耳廓再造与重建方法。方法2003年1月至2012年12月，采用皮肤软组织扩张法，利用健耳相片，通过计算机photoshop软件数字化翻转处理形成即要再造耳廓的相片，然后进行耳廓软骨支架的雕刻，用扩张后的患耳乳突区皮瓣覆盖雕刻的自体肋软骨耳廓支架行耳廓再造。结果1102例（1165耳）经过6个月一10年的随访观察。其中56例（56耳）再造耳廓有不同程度的软骨吸收、变形；2例（2耳）肋软骨支架感染、肋软骨液化、坏死；1044例（1107耳）再造耳廓与健耳匹配，凹凸结构显示清晰，形状相似、逼真，颅耳角的角度与健耳对称。结论用皮肤软组织扩张法行耳廓再造，术中应用数字化技术形成患耳相片指导自体肋软骨耳廓软骨支架的雕刻，效果满意、并发症少，是先天性小耳畸形较好的治疗方法。

异体脱细胞真皮基质在烧伤后遗畸形中的应用

目的：探索一种治疗烧伤后遗畸形的方法。方法：针对各关节烧伤后遗瘢痕松解切除后创面，采用异体脱细胞真皮基质与刃厚皮形成复合皮片移植一步法修复。2002～2005年共对31例患者进行手术治疗，术后随访半年至2年。结果：移植皮片颜色与周围正常皮肤颜色接近，皮片柔软，瘢痕增生不明显，关节功能较术前显著改善。结论：异体脱细胞真皮基质与刃厚皮形成复合皮片移植是一种较理想的治疗烧伤后遗瘢痕方法，值得推广应用。

烧伤后期瘢痕整形儿复合植皮手术的美容效果分析

目的探讨烧伤后期瘢痕整形儿复合植皮手术的美容效果。方法选择医院接诊的80例烧伤后期整形患儿作为研究对象,根据就诊顺序分为2组,单数为观察组,双数为对照组,各40例,均进行美容治疗,对照组使用自体中厚皮片移植治疗,观察组使用异体脱细胞真皮基质和自体中薄皮片移植治疗,术后均给予常规输液、止血、抗感染治疗。治疗3个月后,比较两组二次手术率、皮片成活率,以及两组OSAS瘢痕评价量表评分及瘢痕增生程度。结果观察组二次手术率明显低于对照组,成片成活率明显高于对照组(2.50%vs 22.50%,95.00%vs 72.50%)(P<0.05);观察组瘢痕颜色、平整度、弹性程度得分均明显优于对照组(0.47±0.07 vs 0.69±0.11,0.51±0.06 vs 0.78±0.10,0.42±0.05 vs 0.94±0.14)(P<0.05);观察组瘢痕重度增生发生率明显低于对照组(12.50%vs 42.50%(P<0.05)。结论烧伤后期瘢痕患儿使用异体脱细胞真皮基质复合自体中薄皮片的整形治疗效果显著,可有效修复瘢痕颜色、平整度、弹性程度,减轻瘢痕增生程度,恢复皮肤美观,美容效果优异。

烧伤后耳廓缺损的修复

目的探讨烧伤后耳廓缺损的治疗方法。方法总结2003年1月—2010年6月期间25例(25耳)烧伤后耳廓缺损患者,局部瘢痕轻的19例(19耳)采用局部皮肤扩张自体肋软骨支架移植行耳廓再造,局部无正常皮肤的6例(6耳)应用颈部扩张皮瓣上提及自体肋软骨支架行耳廓再造。结果随访6个月～3年,25例(25耳)效果均满意:耳廓的位置、大小和健耳相似;移植的软骨支架无吸收、变形;再造耳廓皮肤色泽红润、感觉正常。结论皮肤扩张法自体肋软骨支架行耳廓再造,疗效满意、并发症少,是烧伤后耳廓缺损较好的治疗方法。

皮肤扩张法耳廓再造术修复烧伤后不同程度耳廓缺损

目的探讨皮肤扩张法耳廓再造术在烧伤后耳廓不同程度缺损修复中的应用效果和操作要点。方法手术分两期进行：一期行耳后乳突区皮肤扩张器植入术；二期取出扩张器，形成蒂在前方的耳后皮瓣及耳后皮下组织筋膜瓣，采取自体肋软骨雕刻成耳支架，将耳支架植入耳后皮瓣与筋膜瓣之间，乳突区创面植以中厚皮片，共修复33例烧伤后耳缺损患者。结果33例患者术后皮瓣血运良好，无坏死，植皮均成活，6～12个月以后外形良好，形态逼真，立体感强，耳轮、对耳轮、三角窝均清晰可见，耳廓无明显异位或变形吸收，无明显挛缩。再造耳廓外形满意。结论皮肤扩张法耳廓再造术应用于烧伤性耳廓不同程度缺损畸形的耳廓再造，是一项切实可行的手术方法。

皮肤扩张下自体移植软骨超微结构实验研究

目的 为进一步认识皮肤扩张后自体移植软骨超微结构的变化。方法 运用透射电镜和扫描电镜观察新西兰兔皮肤扩张下自体移植软骨的超微结构。结果 透射电镜观察 :在幼兔组中发现形态变异软骨细胞 ,表面突起变细 ,粗面内质网减少 ,未见高尔基复合体 ,胞质中出现大小不等圆形脂滴空泡 ,约占细胞总数 1/4;在成年兔组中发现大多数软骨细胞明显增大 ,形态不规则 ,细胞质中出现越来越多的脂滴空泡并互相融合成大空泡 ,甚至占据细胞质大部分空间 ,周边细胞器逐渐萎缩、消失。扫描电镜下见移植软骨表面被覆纤维结缔组织 ,其下软骨生长好 ,形态佳。结论 脂滴是脂质在转化为贮存形式的代谢途径中所形成的可见物 ,也是细胞退化的标志。由于自体软骨移植不存在排异反应 ,容易成活。

皮肤扩张对自体移植软骨生长的影响

目的 研究皮肤扩张对自体移植软骨生长的影响。方法 4周龄新西兰白兔耳郭软骨 1.5cm× 1cm行兔背部皮下移植 ,第一组移植前背部皮肤用 2 5ml皮肤扩张器扩张 2周 ,第二组移植前背部皮肤未扩张 ,第三组成年新西兰白兔耳郭软骨 1.5cm× 1cm行兔背部皮下移植 ,移植前皮肤用 5 0ml皮肤扩张器扩张 3周。 2个月后取出移植软骨 ,做移植软骨面积测定及组织学观察。结果 第一组软骨增长了 96 .91% ,第二组软骨增长了 46 .97% ,第三组软骨增长了 4.75 5 %。光镜下观察表明幼兔软骨细胞生长活跃 ,在第一组中尤为明显 ,而成年兔软骨细胞则大多退化。结论 幼龄兔皮肤扩张后自体移植软骨是可增长的 ,为临床上应用皮肤扩张器进行耳郭重建提前至幼儿期进行提供了客观依据。

自体肋软骨联合耳后旋转皮瓣矫正重度隐耳畸形

目的:探讨自体肋软骨联合耳后旋转皮瓣矫正重度隐耳畸形的临床效果。方法:2016年7月-2019年2月对5例先天性重度隐耳患者(5只患耳)取自体肋软骨雕刻成三片软骨片,移植并使耳廓上半部软骨多方向加厚及加强,充分减张后,耳后旋转皮瓣转移至耳轮前覆盖外露软骨。结果:本组5例患者术后切口均愈合良好,耳廓外形挺立,形态佳,术后随访6~9个月,形态稳定,均无复发,效果满意。结论:自体肋软骨加强重度隐耳患者薄弱及卷曲耳廓软骨上部,耳后皮瓣转移至前减少皮肤张力,两者结合使重度隐耳畸形得以稳定矫正。

脱细胞异体真皮加自体刃厚皮复合移植在创面修复中的临床应用

目的寻找功能部位深度烧伤创面与瘢痕畸形修复的理想覆盖材料。方法将功能部位的深度烧伤创面和瘢痕切除后，创面行脱细胞异体真皮＋自体刃厚皮复合移植。结果25例患者复合皮全部成活，复合皮光滑柔软，局部弹性好，关节功能恢复良好。结论脱细胞异体真皮＋自体刃厚皮是功能部位创面修复的理想覆盖材料。

异种脱细胞真皮与自体薄皮片联合移植临床研究

目的 探讨异种（猪）脱细胞真皮与自体薄皮片复合移植修复深度烧伤创面和瘢痕切除创面的可行性，为烧伤治疗寻找新的填充物与覆盖材料。方法 用胰酶消化法脱除断层猪的上皮细胞，制成细网状无细胞真皮支架，再与自体薄皮片联合移植修复各类创面。结果 用于切痴创面移植１８例，成活率７８％；用于瘢痕切除创面移植１１例，成活率９１％；用于肉芽创面移植４例，成活率 １００％。愈后创面外观平整，柔软有弹性，关节部位功能恢复良好，与单纯使用薄皮片移植的创面比较有明显区别。结论 异种（猪）脱细胞真皮能长期存活在人体中，具有组织填充、抑制瘢痕增生的作用，与自体薄皮复合移植是治疗大面积深度烧伤创面和瘢痕切除创面较理想方法。

脱细胞异体真皮联合自体薄皮混合移植在深度烧伤治疗中的应用效果分析

目的观察脱细胞异体真皮联合自体薄皮混合移植在深度烧伤治疗中的应用效果。方法以我院2014年1月至2015年1月诊治的40例深度烧伤患者为研究对象,随机分为研究组与对照组各20例。研究组采用脱细胞异体真皮联合自体薄皮混合移植的方式治疗,对照组采用脱细胞异体真皮移植的方式治疗,观察两组患者烧伤部位的愈合情况以及移植皮片的存活率,在治疗半年后对患者进行随访,观察患者的皮肤愈合情况以及功能恢复情况。结果研究组移植成活率为95%(19/20),显著高于对照组的70%(14/20),差异有统计学意义(P<0.05)。术后3周、6周、9周,研究组的烧伤面积均显著少于对照组,差异有统计学意义(P<0.05)。结论脱细胞异体真皮联合自体薄皮混合移植在深度烧伤治疗中具有较好的临床应用效果。

先天性小耳畸形外耳再造的临床应用及研究

【目的】探讨先天性小耳畸形手术修复的理想方法。【方法】30例患者,采用皮肤扩张器,行耳后皮肤扩张以提供皮源,以自体肋软骨为耳支架,进行外耳再造。【结果】共30例经8年随访观察,再造耳廓皮瓣颜色、柔软度、感觉功能方面都达到了较好效果,且轮廓清晰,患者基本上都比较满意。【结论】经耳后扩张皮肤后,为耳再造术提供了充足的皮肤,结合自体的肋软骨支架移植,是外耳再造较理想的方法。

指背动脉皮瓣联合自体大张皮移植修复在深度热压伤创面中的应用

目的探讨指背动脉皮瓣联合自体大张皮移植修复深度热压伤创面的临床效果。方法 56例(68指)指背深度热压伤患者按治疗方法的不同分为两组。对照组28例(33指)行自体大张皮移植修复,研究组28例(35指)行指背动脉皮瓣联合自体大张皮移植修复,比较两组的指成活率及修复效果。结果研究组的指成活率显著高于对照组,修复效果显著优于对照组(P<0.05)。结论指背动脉皮瓣联合自体大张皮移植修复深度热压伤创面的效果显著,可明显提高指成活率,促进指功能恢复。