带真皮下血管网游离植皮在非洲黑种人病例中的应用

背景:带真皮下血管网的游离植皮术在亚洲人群中的应用有很多成功经验,该术式是否也适用于黑色人种。目的:分析带真皮下血管网的游离植皮术在黑种人病例中应用的可行性和优越性。设计:病例分析。单位:尼日尔国马拉迪省医院。对象:选择1998-11/2001-04在非洲尼日尔国马拉迪省医院接受真皮下血管网游离植皮术的黑种人瘢痕挛缩畸形患者24例,排除新近烧伤或其他外伤的皮肤缺损患者,共49处植皮,年龄9个月￣20岁,患者或其监护人均知情同意。方法:采用塚田貞夫的手术方法,在对侧下腹部,平行于腹股沟切取比皮肤缺损范围稍大的全层皮肤,供皮区可直接拉拢缝合。用手术剪将所切取的皮片进行修整,去除多余的脂肪,保留好真皮下血管网及真皮下脂肪2mm,根据受区的大小形状剪裁,植入受区后对边缝合。术后采用打包敷料7￣10d,10￣14d拆线,其他术后护理常规进行。术后定时随访。主要观察指标:术后植皮的成活情况及功能恢复情况。结果:24例患者全部进入结果分析,无脱落。随访3￣18个月,平均6个月。24例患者,49处植皮除部分植皮区局部坏死以外,植皮的成活率为91.6%,最大的植皮范围15cm×6cm。植皮区皮肤外观和质地接近正常,无再挛缩畸形,功能满意。结论:带真皮下血管网游离植皮术可以在非洲黑色人群中常规应用。

Transfer of free skin grafts with a preserved subcutaneous vascular network in African black patients

BACKGROUND: Burns or traumatic scare can sometimes result in contractures especially when occurring in African blacks. The fat-free skin graft has been applied frequently to treat them and in some cases, it has failed to take.Preserved subcutaneous vascular network (PSVN) skin transplantation were successfully uses in Asian areas.OBJECTIVE: To analyze the feasibility and superiority of preserved subcutaneous vascular network (PSVN) skin transplantation in African black people.DESIGN: A prospective clinical study.SETTING: Maradi Province Hospital of Niger.PARTICIPANTS: From November 1998 to April 2001, 49 free skin grafts with PSVN in 24 patients aged from 9 months to 20 years were performed by a single surgeon (WH) as a member of a Chinese Medical Team in Maradi Province Hospital of Niger. The newly burnt patients and those with other traumatic skin defects were excluded. All the enrolled patients were informed with the intervention and agreed to be operated.METHODS: The current approach of preserved subcutaneous vascular network (PSVN) was based on the original technique described by Tsukada. Bloc excision including a relatively massive amount of fat tissue was performed from the contralateral inferior quadrant of the abdomen. The fat layer was carefully trimmed away with a pair of scissors, exposing the vascular network plane, which should be well protected from injury, leaving a slight layer of about 2 mm of attached fat. Once this was done, the graft was placed on the recipient sites. Four corner sutures were placed to hold the graft in the proper orientation, following by sutures placed around the periphery. Occasionally, central sutures might be indicated to ensure adherence of the graft over a concave portion of wound, but this need not be done routinely. A pressure dressing pack was then applied on the PSVN skin graft for about 7 to 10 days. Sutures were moved after about 10 to 14 days. Post-operative care was as usual. Fo,owing-up was performed ordinarily.MAIN OUTCOME MEASURES: Survival and functional recovery of the skin grafts postoperatively.RESULTS: All the 24 patients were included in this clinical study and analysis. The 49 free skin grafts with PSVN healed without difficulty or complication in 24 patients, with some cases of tiny, superficial blisters and spot necrosis, the surface area of the largest graft measured 15 cm×6 cm, 91.6 % of the grafts were successful. The resulting surface had good appearance texture without secondary contracture and satisfactory function when observed over an average follow-up of 6 months (3 to 18 months).CONCLUSION: The technique of preserved subcutaneous vascular network (PSVN) skin transplantation could be used with satisfactory results in African black people.