双层人工真皮联合诱导膜技术修复足踝部皮肤缺损伴感染的疗效  

Efficacy of double-layer artificial dermis combined with Masquelet technique in repairing skin defect of foot and ankle with infection

作　　者：张清林[1] 荣存敏[1] 王美灵 陈磊[1] 栗威[1] 张磊[1] ZHANG Qing-lin;RONG Cun-min;WANG Mei-ling;CHEN Lei;LI Wei;ZHANG Lei(Dept of Hand and Foot Surgery,the Affiliated Hospital of Jining Medical University,Jining,Shandong 272029,China)

机构地区：[1]济宁医学院附属医院手足外科,山东济宁272029

出　　处：《临床骨科杂志》2024年第5期675-679,共5页Journal of Clinical Orthopaedics

基　　金：山东省中医药管理局中医药科技发展项目(编号:2019-0470);山东省济宁市科技局重点研发计划项目(编号:2022YXNS062)。

摘　　要：目的 探讨双层人工真皮联合诱导膜技术修复足踝部皮肤缺损伴感染的疗效。方法 按创面缺损修复方式不同将64例足踝部皮肤缺损伴感染患者分为对照组(采用双层人工真皮修复后全厚皮片移植治疗,32例)和观察组(采用双层人工真皮联合诱导膜技术修复后全厚皮片移植治疗,32例)。记录两组人工真皮血管化时间、创面感染情况、移植皮片成活情况。采用温哥华瘢痕量表(VSS)评分评价植皮区瘢痕情况,采用AOFAS踝-后足评分评估踝关节功能恢复情况。结果 患者均获得12个月随访。人工真皮血管化时间观察组短于对照组(P<0.05)。移植皮片成活率观察组高于对照组(P<0.05)。创面感染率观察组低于对照组(P<0.05)。术后12个月VSS评分、AOFAS踝-后足评分两组比较差异均无统计学意义(P>0.05)。结论 双层人工真皮联合诱导膜技术修复足踝部皮肤缺损伴感染,手术操作相对简单易行,对供区损伤小,且可以明显缩短双层人工真皮血管化时间,提高创面修复成功率,降低创面感染率。Objective To explore the efficacy of double-layer artificial dermis combined with induction membrane technique(Masquelet technique)in repairing skin and soft tissue defects of the foot and ankle with infection.Methods The 64 patients who suffered from skin defects of feet and ankles with infection were divided into control group(32 cases were treated with double-layer artificial dermis and full-thickness skin graft)and observation group(32 cases were treated with full-thickness skin graft after repair with double-layer artificial dermis combined with Masquelet technique).The vascularization time of the artificial dermis,wound infection and graft survival were recorded.Vancouver scar scale(VSS)was used to evaluate the scar of skin graft area,and AOFAS ankle-hindfoot score was used to evaluate the functional recovery of ankle joint.Results All patients were followed up for 12 months.The vascularization time of artificial dermis in observation group was shorter than that in control group(P<0.05).The survival rate of skin graft in observation group was higher than that in control group(P<0.05).The wound infection rate in the observation group was lower than that in the control group(P<0.05).At 12 months after operation,there were no significant differences in VSS and AOFAS ankle-hindfoot scores between the two groups(P>0.05).Conclusions The double-layer artificial dermis combined with Masquelet technique for repairing the skin defect of foot and ankle with infection are relatively simple and easy to operate,with less damage to the donor site,and which can obviously shorten the vascularization time of double-layer artificial dermis,improve the success rate of wound repair,and reduce the rate of wound infection.

关 键 词：人工真皮 诱导膜技术 皮肤缺损 骨外露 肌腱外露 足踝部损伤 

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