双层人工真皮修复指端皮肤缺损的临床疗效观察  

Clinical curative effect of double-layer artificial dermis in repairing fingertip skin defects

作　　者：李哲帮 姚忠军 赵飞 刘东 LI Zhe-bang;YAO Zhong-jun;ZHAO Fei;LIU Dong(Graduate School of Jinzhou Medical University,Shiyan 442000,Hubei,China;Shiyan Taihe Hospital,Hubei University of Medicine,Shiyan 442000,Hubei,China)

机构地区：[1]锦州医科大学研究生院,湖北十堰442000 [2]十堰市太和医院(湖北医药学院附属医院),湖北十堰442000

出　　处：《生物医学工程与临床》2021年第1期58-61,共4页Biomedical Engineering and Clinical Medicine

摘　　要：目的探讨双层人工真皮在修复指端皮肤缺损中的临床疗效。方法选择2018年1月至2019年6月因外伤致手指末端皮肤软组织缺损91例(102指),64指合并部分末节指骨外露,其中男性60例,女性31例;年龄18~61岁,平均年龄36.3岁。彻底清创后,应用双层人工真皮覆盖创面,术后定期换药、包扎,4~6周后拆除人工真皮硅胶膜,观察创面愈合情况及感染情况。测量手指末端两点辨别觉。根据温哥华瘢痕量表(VSS)评价有无瘢痕形成。结果91例患者均获得随访,随访时间为3~6个月,平均随访时间4.2个月。66例患者(75指)人工真皮覆盖后皮肤软组织缺损创面全部一期愈合,未见指骨外露,未见感染。25例患者(27指)仍有部分创面残留,经二期植皮后创面愈合。所有患指创面愈合后外观良好,质地坚韧,无色素沉着;VSS评分0~4分,无明显增生性瘢痕形成;无手指臃肿,感觉恢复良好,术后3个月两点辨别觉3~6 mm。结论双层人工真皮在修复手外伤后指端皮肤软组织缺损及合并部分末节指骨外露创面中操作简单,疗效确切,创面愈合后外形及功能满意,无需行皮瓣移植修复及残端修整,最大限度恢复患指功能。Objective To explore clinical efficacy of double-layer artificial dermis in repairing of fingertip skin defects.Methods From January 2018 to June 2019,a total of 91 cases(102 fingers,64 fingers combined with partial exposure of distal phalanx)of skin and soft tissue defects at fingertip were enrolled,which included 60 males and 31 females,aged 18-61 years old with mean age of 36.3 years old.The double-layer artificial dermis was covered after completely debridement.The dressing was changed regularly after operation,and artificial dermal silicone membrane was removed after 4-6 weeks,wound healing and infection was observed.The two-point recognition at fingertip was measured,and scar formation was evaluated by Vancouver scar scale(VSS).Results The 91 patients were followed up for 3-6 months,with mean follow-up of 4.3 months.Sixty-six patients(75 fingers)of artificial dermis covered skin soft tissue defect wounds were first-stage healed,without phalanx exposure and infection.Besides,part of the wounds remained in 25 patients(27 fingers),and these wounds were healed after secondary skin grafting.The healed wounds of affected fingers showed good appearance tough texture and without pigmentation.The VSS scores was 0-4,which without obvious hypertrophic scar formation and bloated fingers.Two-point discrimination was 3 to 6 mm at 3-month post operation.Conclusion It is demonstrated that double-layer artificial dermis is simple and effective in repairing skin and soft tissue defects of fingertips and part of exposed wounds of distal phalanx after trauma.After healed,the appearance and function are satisfactory,without skin flap transplantation and stump trimming,and function of affected finger could be maximized.

关 键 词：人工真皮 指端皮肤缺损 伤口愈合 手外科 

分 类 号：R622.1[医药卫生—整形外科] R658.2[医药卫生—外科学]