人工真皮复合自体刃厚皮片修复关节处皮肤缺损创面的临床研究

摘要

目的：探讨人工真皮复合自体刃厚皮片对全身关节处皮肤缺损创面的疗效及愈后。方法收集2008～2013年采用人工真皮复合自体刃厚皮片修复关节处皮肤缺损创面25例，其中创面覆盖膝关节10例，踝关节5例，肘关节4例，腕关节2例，指关节间3例，腋窝部1例。观察其手术后皮片存活情况，术后3个月瘢痕形成程度及功能恢复情况。结果在采用人工真皮复合自体刃厚皮片治疗方法的患者中，18例患者一期术后通过换药及时清除脓性分泌物，类真皮样肉芽组织形成良好，3例患者人工真皮下出现感染，通过清洁换药，引流脓液后，类真皮样肉芽组织可再次形成。2例患者因感染较重，通过再次手术彻底清创并更换人工真皮，获得同样疗效，二期植皮术后，皮片均贴附良好。2例患者创面面积小，揭除人工真皮薄膜后，创面通过周围正常上皮爬行覆盖，自行愈合。术后3个月随访患者关节功能恢复良好，无明显瘢痕增生级瘢痕挛缩形成。结论人工真皮复合自体刃厚皮片疗法不仅能提高创面自体皮片移植成活率，并可有效降低关节处瘢痕挛缩程度，为患者的远期关节功能恢复，提供有效的治疗方案。%Objective To investigate the efficacy and prognosis of artificial dermis combined with autologous skin graft in the body joints dermal wounds.Methods Twenty-five cases were collected from 2008 to 2013,who used artificial dermis combined with autologous skin graft repair articular wounds,including 10 cases of wound knee,5 cases of the ankle,4 cases of the elbow,2 cases of the wrist,3 cases of the knuckles,1 case of the axillary.Skin graft survival after surgery,the extent and functional recovery of scar formation after 3 months were observed.Results Among the patients,who underwent artificial dermis combined with autologous skin graft repair operations,dermal tissue of 1 8 cases formed well by timely removal of pus after phase one surgery.Three cases suffered artificial dermis infection,and the dermal tissue formed again after the clean dressing and drainage of pus.Two cases with severe infection underwent surgical debridement and replacement of artificial dermis,and the same treatment effect was achieved. After skin graft of phase two,autologous skin lives well.Wound area of 2 cases is small,with striping of artificial dermis film,the wound covered by the surrounding normal epithelium,and healed themselves.It shows good recovery of function in patients after 3 months follow-up,and no formation of obvious scar and scar contracture.Conclusion Artificial dermis combined with autologous skin graft therapy can not only improve the survival rates of autologous skin graft,but reduces the degree of scar contracture of joints and the long-term function recovery,and it provides an effective treatment program for tissue wounds.