人工真皮复合自体刃厚皮移植与自体皮瓣移植修复手部深度软组织缺损的比较研究

目的:比较人工真皮复合自体刃厚皮移植与自体皮瓣移植在修复手部深度软组织缺损中的临床效果.方法:选取2013年1月-2016年12月我科收治的手部深度软组织缺损患者22例,按手术方法不同分为两组,观察组采用人工真皮联合自体刃厚皮修复手部缺损,对照组采用自体皮瓣进行修复.采用温哥华瘢痕量表评分比较两组患者术后随访半年期间手部及供区瘢痕增生情况,观察术后手部外观及功能恢复情况、患者对治疗效果的满意度等.结果:术后随访半年,观察组手部瘢痕增生评分(2.27±1.19)分]明显少于对照组(4.09±1.83)分];观察组供皮区瘢痕增生评分(1.02±0.94)分]明显少于对照组(5.27±2.15)分];术后外观上,观察组无明显异常,对照组则臃肿明显,其中8例选择进行二次修复手术;观察组手功能恢复明显优于对照组;患者满意度(90.9％)高于对照组(63.6％).结论:对于手部深度组织缺损的修复,应用人工真皮联合自体刃厚皮进行修复效果确切,术后手部瘢痕增生少,功能恢复好,供区损伤大大降低,相比自体皮瓣进行修复拥有明显优势.

Comparison of the effect of artificial derma combined with autologous split-thick skin grafting and autologous skin flap transplantation in repairing deep burn in hand

Objective:To compare the clinical effect of artificial dermis conbined with autologous split-thick skin grafting and autologous skin flap grafting in repairing deep burn of hands' soft tissue.Methods:Twenty-two patients with deep burn of hands' soft tissue admitted in the Department of Burns and Plastic Surgery from Jan.2013 to Dec.2016 were divided into two groups according to the treatment method selected by the patients.The wounds of the patients in the observation group were repaired by artificial dermis combined with autologous split-thick skin grafting,and in the control group by autologous skin flap grafting.The patients were followed up for six months,the hyperplasia of scar in the burned area and donor site was assessed by Vancouver Scar Scale,and the appearance of the repaired hands,functional recovery and the degree of patients' satisfaction to the outcome were observed.Results:Following up for 6 months,the scores of Vancouver Scar Scale were less in the observation group both in burned area (2.27±1.19) and donor site (1.02±0.94) than those in control group (4.09±1.83 and 5.27±2.15,respectively) with significant differences (P＜0.05).No obvious abnormity appeared in the burned area in observation group,but it appeared bloating in control group,among which 8 cases received the second surgery repair.The functional recovery of the burned hand in observation group was superior to that in control group,and the surgery outcome was more satisfactory to the patients in observation group (90.9％) than in control group (63.6％).Conclusions:Treatment with artificial dermis and autologous split-thick skin shows clear effect in repairing the deep defect of hands' soft tissue,with mild scar hyperplasia,good functional recovery and less damage to the donor site compared to that with autologous skin flap repairing.