网状脱细胞异体真皮基质联合自体刃厚皮片复合移植修复小儿爪形手  

Application of meshed acellular allogeneic dermal matrix and split thickness autogenous skin graft for the treatment of pediatric claw hand

作　　者：王伊宁[1] 齐鸿燕[1] 

机构地区：[1]首都医科大学附属北京儿童医院烧伤整形科,100405

出　　处：《中华整形外科杂志》2017年第3期187-190,共4页Chinese Journal of Plastic Surgery

摘　　要：目的探索应用网状脱细胞异体真皮基质与自体刃厚皮片复合移植，修复小儿爪形手的可行性。方法2013年1月至2016年3月，对13例（20只手）小儿烫伤后形成的爪形手进行修复，术中彻底切除瘢痕、矫正畸形，创面6cm×6cm～10cm×17cm，均位于手背部和近节指背部。以网状脱细胞异体真皮基质覆盖创面，取自体刃厚皮覆于异体真皮基质上，二者形成复合皮。克氏针和石膏固定制动。术后2周打开植皮包堆纱布，术后3周拔除克氏针，同时佩戴矫形支具和弹力手套。结果2周拆线时见移植复合皮成活率70％～100％，平均90％。其中2例（3只手）皮片成活70％，再次行复合皮移植后得到矫正；5例（7只手）植皮区出现小水疱或表皮坏死，经换药后愈合；其余6例（10只手）均一期完全成活。共10例（17只手）获得10～24个月随访，皮片柔软、弹性好，色泽与正常皮肤接近。按关节主动活动范围评定法（TAM法）评价关节功能：优4只，良11只，中2只。结论脱细胞异体真皮基质与自体刃厚皮片复合移植可有效改善小儿爪形手外观及功能，同时避免了因采取自体全厚皮片遗留瘢痕的问题。Objective To explore the methods and the clinical effect of composite skin graft with meshed acellular allogeneic dermal matrix（allo-ADM） and split thickness autogenous skin graft for pediatric claw hand. Methods From January 2013 to March 2016, acellular allogeneic dermis matrix（allo-ADM） with split thickness autogenous skin graft was applied for 13 cases （20 hands） of burned pediatric claw hands. The size of the wounds ranged from 6cmx6cm to 10cmxl7cm, located in the back of the proximal phalanx and hand. The sear was totally excised and hands＇ deformities were corrected, with allo-ADM and split thickness autogenous skin graft to cover the wounds. Kirschner wire and plaster fixation, graft gauze bag pile were released 2 weeks after surgery, following by wearing a brace and elastic glove for rehabilitative therapy. Results 2 weeks after transplantation the composite skin survival rate was 70% - 100% ; 10 cases（ 17 hands） were followed up for 10 months to2 years. The skin graft survival rate was 70% in 2 cases（3 hands）, who underwent secondary operation to correct deformity. The composite skin graft survival rate was above 90% in 8 cases （14 hands）. Long term follow-up results showed that composite skin graft had satisfactory elasticity and color. According to the active range assessment of joint movement （TAM method）, the results were excellent （TAM% equals to 100%） in 4 hands, good （TAM% was greater than 75% ） in 11 hands and acceptable （TAM% was equal to 50% ） in 2 hands. Conclusions Composite transplantation of acellular allogeneic dermis matrix with spit thick autogenous skin graft can effectively improve the appearance and function of children＇s claw hand, while avoiding the scar formation due to the harvest of full thickness skin.

关 键 词：异种移植物 爪形手畸形 儿童 移植 

分 类 号：R726.5[医药卫生—儿科]