人工真皮复合自体薄皮移植治疗皮肤软组织缺损

背景：修复皮肤软组织缺损自体或异体植皮治疗,往往需要多次植皮。而国内临床上应用人工真皮较少,应用经验亦不足。目的：评价人工真皮治疗皮肤软组织缺损的疗效。方法：收集因皮肤软组织缺损,行人工真皮结合自体薄皮移植修复创面的22例患者,其中骨外露6例,肌腱外露2例,表皮肿瘤切除3例,其他11例。一期清创移植人工真皮,2～4周后局部肉芽组织生长良好,外露肌腱、骨组织被类真皮组织覆盖,二期移植自体薄层皮片。观察取皮部位、损伤部位、操作性能、密封性、不良反应情况,结合评价临床效果及综合评价。结果与结论：20例患者人工真皮结合二期自体薄皮移植全部存活,至二期植皮所需时间（18.50±4.27）d,其中1例患者因感染再次手术,2例患者行人工真皮后未行二期植皮,而自动上皮化;随访至3个月,21例损伤部位表皮生长性、外观性均良好、无瘢痕增生,1例因感染而致瘢痕增生严重、外观不良,但生长性良好;20例患者取皮部位无明显的色素沉着及色素脱出,无严重增生性瘢痕,上皮形成时间为（15.35±4.67）d。说明人工真皮结合自体薄皮移植修复皮肤软组织缺损,操作简便,创面愈合质量高,供皮区损伤轻微,至二期植皮时间较长,总体临床效果良好。

Artificial dermis combined with autologous thin skin transplantation for repair of soft tissue defects

BACKGROUND：Multiple skin transplantations are needed when repair soft tissue defects by skin grafting.Artificial dermis is rare used in clinic,and the experience is insufficient.OBJECTIVE：To evaluate curative effect of artificial dermis for repair soft tissue defects.METHODS：A total of 22 cases underwent artificial dermis with autologous thin skin transplantation were selected,including 6 cases with bone exposure,2 with tendon exposure,3 with resection of skin tumor,and 11 with others.Debridement and artificial dermis transplantation was performed firstly,followed by split thickness autoskin transplantation when the local granulation tissue grew well and the exposed tendon or bone tissue was covered by dermis-like tissues.The area of taking the skin,site of injury,operating performance,sealing,side effects were observed.The clinical and overall results were evaluated.RESULTS AND CONCLUSION：All cases had good coverage of wounds and graft survival.18.50±4.27 days were needed to secondly skin grafting.One case performed a second surgery due to infection,2 cases with automatic epithelization did not need secondly skin transplantation.Until to 3 months follow-up,epidermal growth and appearance of injury site are all good without scar in 21 cases.One case had scar and unhealthy appearance because of infection,but epidermal growth was also good.The area of taking the skin had no pigmentation and pigment prolapse,no serious scar in 20 cases,with 15.35±4.67 days to epithelialization.Repair of skin and soft tissue defects with artificial dermis has high quality of wound healing,minor injury to the area of taking site,and take longer time to secondly skin grafting.The overall clinical effect is good.