双层人工真皮在合并大面积皮肤及皮下组织缺损再植中的应用  

Application of double layer artificial dermis in replantation of severed fingers and toes with large skin and subcutaneous tissue defect

作　　者：李中成 刘雪涛[1] 丁伟 于子云 刘超[1] 耿士亮 LI Zhongcheng;LIU Xuetao;DING Wei(Department of Hand Surgery,The PLA Army 80th Group Army Hospital,Weifang,Shandong,261000,China)

机构地区：[1]中国人民解放军陆军第80集团军医院全军创伤骨科研究所骨科手外一组,山东潍坊261000

出　　处：《实用手外科杂志》2022年第3期321-323,343,共4页Journal of Practical Hand Surgery

摘　　要：目的探讨应用组织工程产品双层人工真皮修复材料覆盖复杂断指(趾)再植时大面积皮肤及皮下组织缺损创面的临床治疗效果。方法2020年6月-2021年6月,收治的8例伴大面积皮肤及皮下组织缺损的复杂断指(趾)再植患者应用新型组织工程产品双层人工真皮一期修复再植时皮肤皮下组织缺损创面。双层人工真皮可保护皮下组织及修复的血管神经肌腱等重要组织,还能诱导创面肉芽组织及血管等的生长,二期待指体成活病情稳定后创面均行游离植皮修复。结果本组8例9指(趾)再植后裸露骨质或肌腱均>0.5 cm^(2),不宜一期植皮覆盖创面,再植后予双层人工真皮覆盖,一期再植指(趾)体全部成活,二期游离植皮时均见肉芽组织生长覆盖良好,植皮后皮片成活均良好。术后平均随访4.5个月(2~10个月),比较观察修复术后再植患指(趾)及植皮区的外形、功能、肤色、弹性及感觉,均较传统的皮瓣修复及过度短缩修复效果理想,患者及家属满意度明显提高。结论在伴大面积皮肤及皮下组织缺损的复杂断指(趾)再植中应用双层人工真皮一期修复创面的方法是可行的,治疗效果较传统皮瓣及过度短缩效果满意。Objective To explore the clinical therapeutic effect of tissue engineering product,double-layer artificial dermal repair material,to cover large-area subcutaneous tissue defect wounds during complex replantation.Methods From June,2020 to June,2021,among the complicated replanted patients with large area of subcutaneous tissue defects,we also explored and applied a new tissue engineering product,double-layer artificial dermis,to repair the wounds of subcutaneous tissue defects after replantation.On the one hand,double-layer artificial dermis not only protected subcutaneous tissue and repaired important tissues such as blood vessels,nerves and tendons,but also induced the growth of granulation tissue and blood vessels in wounds.On the other hand,it was expected that all wounds would be repaired by free skin grafting after the fingers survive and became stable.Results Retrospectively,the number of cases in which the new tissue engineering product,double-layer artificial dermis,was used to repair the skin subcutaneous tissue defect wounds in the first stage of replantation was 8 fingers(toes)and 9 fingers(toes),including 6 fingers and 2 toes.After replantation,the bare bones or tendons were all larger than 0.5 cm^(2),so it was not suitable to cover the wounds with primary skin grafting,but double-layer artificial dermis in the first stage of replantation,all the fingers(toes)survived in the first stage of replantation,and the granulation tissue growth was covered in the second stage of free skin grafting.After skin grafting,the skin grafts survived well,and the average follow-up time was 4.5 months(February-October).Comparing and observing the shape,function,skin color,elasticity and feeling of the replanted afiected finger(toe)and skin grafting area after repair,the efiect was better than that of traditional skin flap repair and excessive shortening repair,and the satisfaction of patients and their families was significantly improved.Conclusion It is feasible to use double-layer artificial dermis in one-stage repair

关 键 词：双层人工真皮 大面积缺损 再植 皮瓣 短缩 应用 

分 类 号：R658[医药卫生—外科学]