双层人工真皮复合自体皮移植修复骨质和/或肌腱外露创面的临床疗效  

Clinical effect of bi-layered artificial dermis and autologous skin graft in repairing bone and/or tendon exposed wounds

作　　者：李敏雄 马军[1] 郑紫君 牛利斌[1] 杨磊[1] Li Minxiong;Ma Jun;Zheng Zijun;Niu Libin;Yang Lei(Department of Burns,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院烧伤科,广州510515

出　　处：《中华烧伤杂志》2020年第3期179-186,共8页Chinese Journal of Burns

基　　金：广东省科技创新战略专项(2018KJYZ005);西藏自治区自然科学基金(XZ2017ZR-ZY021);广州市科技计划(201607010242)。

摘　　要：目的探讨联用双层人工真皮和自体皮移植修复骨质和/或肌腱外露创面的临床疗效。方法回顾性分析2014年5月—2018年12月南方医科大学南方医院收治的25例各类原因致骨质和/或肌腱外露的创面患者病历资料,患者中男21例、女4例,年龄3~79岁,单纯骨质外露7例、单纯肌腱外露13例、合并骨质与肌腱外露5例。创面总面积为78.0(53.4,103.2)cm^2,骨质外露宽度、肌腱外露宽度分别为3.2(3.0,3.6)cm和2.0(1.7,2.4)cm。所有创面彻底清创后Ⅰ期植入双层人工真皮,待2~3周人工真皮血管化后Ⅱ期移植自体薄中厚皮片或刃厚皮片修复创面。观察记录患者人工真皮血管化情况及血管化时间、是否产生血肿,自体皮移植术后7 d皮片成活率、是否重复植皮,创面完全愈合时间,以及患者出院后≥3个月的随访情况。结果24例患者首次移植人工真皮后完成血管化,血管化时间为11~21(16±4)d,且移植的人工真皮均未产生血肿;1例患者移植的人工真皮血管化失败后,改用负压引流及单纯植皮处理,创面愈合后患者出院。自体皮移植术后7 d,皮片成活率为92.2%~100.0%[(99.3±1.3)%],余下创面后期自愈或通过换药处理愈合,未重复植皮。创面完全愈合时间为自体皮移植术后7~19(11.9±2.8)d。患者出院后获3~60个月随访,除植皮区部分有色素沉着外,植皮存活良好、柔软、未出现反复破溃,无明显瘢痕增生挛缩畸形。结论双层人工真皮复合自体皮移植修复骨质和/或肌腱外露创面疗效较佳,为该类创面提供了一种修复策略。Objective To explore the clinical effect of bi-layered artificial dermis combined with autologous skin graft in the repair of wounds with exposed bone and/or tendon.Methods The medical records of 25 patients(aged 3 to 79 years,including 21 males and 4 females)with bone and/or tendon exposed wounds caused by various reasons,admitted to Nanfang Hospital of Southern Medical University from May 2014 to December 2018 were analyzed retrospectively.Of the 25 patients,7 patients had exposed bone only,13 patients had exposed tendon only,and 5 patients had exposure of both bone and tendon.The total wound area was 78.0(53.4,103.2)cm^2.The widths of bone exposure and tendon exposure were 3.2(3.0,3.6)cm and 2.0(1.7,2.4)cm,respectively.All wounds were implanted with bi-layered artificial dermis in the first stage after thorough wound debridement.After 2 to 3 weeks of vascularization of artificial dermis,autologous thin-to-medium-thickness skins or split-thickness skins were grafted to repair the wounds in the second stage.The vascularization of artificial dermis and its time,whether or not producing hematoma,the skin graft survival rate on day 7 post autologous skin grafting,whether or not repeating skin grafting,and the time of complete wound healing were observed and recorded.The patients were further followed up and observed for 3 or more months after discharge.Results The vascularization of artificial dermis was achieved in 24 patients after the first transplantation with vascularization time being 11-21(16±4)days.No hematoma was observed in the transplanted artificial dermis.Failed vascularization of grafted artificial dermis was observed in one patient who was later treated with negative pressure drainage and skin grafting alone,and was discharged with wound healing.The skin graft survival rate on day 7 post autologous skin grafting was 92.2%-100.0%((99.3±1.3)%),with the remaining wound areas recovered later by themselves or healed by dressing changes without repeated skin grafting.The complete wound healing time was 7

关 键 词：皮肤 人工 皮肤移植 移植 自体 创面修复 骨质外露 肌腱外露 

分 类 号：R619+.6[医药卫生—外科学] R329.2[医药卫生—临床医学]