拼接法等面积供皮修复皮肤巨大缺损  

Repair of large skin defect with joined donor grafts of equal size

作　　者：陆鑫锋[1] 顾永贵[1] 赵亮[2] 刘屹球[1] 陈静[1] 张倩[2] 吴剑[1] 

机构地区：[1]江苏省靖江市人民医院,214500 [2]中国医学科学院北京协和医学院皮肤病医院

出　　处：《中华皮肤科杂志》2013年第6期422-423,共2页Chinese Journal of Dermatology

摘　　要：目的 探讨新的供皮区取皮方法,在获取较大面积全厚皮片的同时,可缩短供皮区宽度、减少缝合张力,缺损面可直接缝合闭合.方法 运用数学原理,在面积相等的条件下,设计错位供皮法,所取的皮片经拼接后即可形成较大面积皮片,满足修复大面积缺损的需要.用该方法治疗7例皮肤恶性肿瘤患者,头、面部5例,足部2例,包括基底细胞癌3例,鳞状细胞癌3例,恶性黑素瘤1例.结果 供皮宽度缩小后,供皮区缺损能够直接拉拢缝合,同时也避免供皮区皮源的浪费.7例患者,头面部5例中,3例全部成活,2例边缘少许糜烂；2例足底部约10％～20％坏死,经换药处理,1～2个月后愈合.结论 修复较大面积皮肤缺损,拼接法等面积供皮是一种较好的选择.Objective To develop a new strategy for preparing large-area full-thickness skin grafts with donor incisions small enough to allow direct suture under low pressure. Methods A geometrical analysis was carried out to design the best strategy to obtain skin grafts with minimal donor defect. In this strategy, two semicircular donor skin grafts are subjected to a malpositioned joining to form a circle which is equal in size to the large-area skin defect. Seven patients with cutaneous malignancy were managed by this operation regimen, including three cases of basal cell carcinoma, three cases of squamous cell carcinoma, and one case of malignant melanoma. Tumors were located in the face or head in five patients, and in feet in two patients. Results The width of donor incisions was significantly reduced by this strategy, and donor defects were sutured directly with the minimal loss of donor graft. Of the five patients with malignancies of the head or face, three achieved complete survival of skin grafts, two experienced mild erosion at the margin of skin grafts. A 10%-20% necrosis of skin graft was observed in the sole of feet in 2 patients, which healed 1-2 months after dressing changes. Conclusion Joined grafts of equal size may be an effective approach to the repair of large skin defect.

关 键 词：拼接法 供皮修复 皮肤 缺损 

分 类 号：R73[医药卫生—肿瘤]