Abstract：
Artificial dermal substitutes (ADMs) have been trialled to improve outcomes at the donor site following the harvesting of a radial forearm free flap (RFFF). This systematic review compares donor site aesthetic and functional outcomes, with the use of an ADM versus conventional practice.
The databases Medline, Embase, Cochrane Library, Web of Science (Core Collection), and Scopus were searched for retrospective, prospective, and case-control studies and randomised control trials (RCTs) involving any ADM. Studies with adult patients having undergone RFFF harvesting and donor site repair with an ADM, commenting on appropriate clinical outcomes and without high risk of bias, were included. Direction-of-effect analysis was performed on relevant groupings of studies since heterogeneity in outcome measurement precluded meta-analyses.
Across eight non-comparative studies included, 132 patients had donor site coverage with AlloDerm™, Integra™, Matriderm™, or Rapiderm. Across 11 comparative studies included, 240 patients had donor site coverage with fish-skin matrix, AlloDerm™, amniotic membrane, MegaDerm™, Hyalomatrix, Integra™, or Matriderm™. Five out of 11 comparative studies demonstrated superior aesthetic outcomes with ADMs according to at least one aesthetic metric compared to controls, whilst 6/11 demonstrated superior functional outcomes with ADMs. No study demonstrated poorer aesthetic or functional outcomes with an ADM compared to conventional practice.
In summary, the lack of studies reporting poorer outcomes with them compared to conventional practices, and a cumulative effect direction in their favour, provide strong indications in support of the use of AlloDerm™, Integra™, or Matriderm™ grafts. Further comparative studies, including RCTs, are needed to reinforce these initial indications.
The databases Medline, Embase, Cochrane Library, Web of Science (Core Collection), and Scopus were searched for retrospective, prospective, and case-control studies and randomised control trials (RCTs) involving any ADM. Studies with adult patients having undergone RFFF harvesting and donor site repair with an ADM, commenting on appropriate clinical outcomes and without high risk of bias, were included. Direction-of-effect analysis was performed on relevant groupings of studies since heterogeneity in outcome measurement precluded meta-analyses.
Across eight non-comparative studies included, 132 patients had donor site coverage with AlloDerm™, Integra™, Matriderm™, or Rapiderm. Across 11 comparative studies included, 240 patients had donor site coverage with fish-skin matrix, AlloDerm™, amniotic membrane, MegaDerm™, Hyalomatrix, Integra™, or Matriderm™. Five out of 11 comparative studies demonstrated superior aesthetic outcomes with ADMs according to at least one aesthetic metric compared to controls, whilst 6/11 demonstrated superior functional outcomes with ADMs. No study demonstrated poorer aesthetic or functional outcomes with an ADM compared to conventional practice.
In summary, the lack of studies reporting poorer outcomes with them compared to conventional practices, and a cumulative effect direction in their favour, provide strong indications in support of the use of AlloDerm™, Integra™, or Matriderm™ grafts. Further comparative studies, including RCTs, are needed to reinforce these initial indications.
摘要：
背景：人工真皮替代品（ADMs）已经进行了试验，以改善在采集radial前臂游离皮瓣（RFFF）后在供体部位的结果。这篇系统评价比较了供体部位的美学和功能结果，与传统做法相比，使用ADM。
方法：数据库Medline，Embase,科克伦图书馆,WebofScience(核心合集),和Scopus进行了回顾性搜索，prospective,以及涉及任何ADM的病例对照研究和随机对照试验（RCT）。对使用ADM进行RFFF收获和供体部位修复的成年患者的研究，评论适当的临床结果，没有高偏倚风险，包括在内。由于结果测量的异质性排除了荟萃分析，因此对相关研究分组进行了效果方向分析。
结果：包括八项非比较研究，132名患者使用AlloDerm™进行了供体部位覆盖，Integra™,Matriderm™,或者Rapiderm.包括11项比较研究，240名患者用鱼皮基质覆盖了供体部位，AlloDerm™,羊膜,MegaDerm™,Hyalomatrix,Integra™,或Matriderm™。根据至少一种美学指标，与对照相比，11项比较研究中有5项显示ADM具有更好的美学效果。而6/11显示ADM具有更好的功能结果。与常规实践相比，没有研究显示ADM具有较差的美学或功能结果。
结论：总之，缺乏报告与传统做法相比效果较差的研究，和对他们有利的累积效应方向，提供强有力的适应症以支持AlloDerm™的使用，Integra™,或Matriderm™移植物。进一步的比较研究，包括RCT,需要加强这些初步迹象。
方法：数据库Medline，Embase,科克伦图书馆,WebofScience(核心合集),和Scopus进行了回顾性搜索，prospective,以及涉及任何ADM的病例对照研究和随机对照试验（RCT）。对使用ADM进行RFFF收获和供体部位修复的成年患者的研究，评论适当的临床结果，没有高偏倚风险，包括在内。由于结果测量的异质性排除了荟萃分析，因此对相关研究分组进行了效果方向分析。
结果：包括八项非比较研究，132名患者使用AlloDerm™进行了供体部位覆盖，Integra™,Matriderm™,或者Rapiderm.包括11项比较研究，240名患者用鱼皮基质覆盖了供体部位，AlloDerm™,羊膜,MegaDerm™,Hyalomatrix,Integra™,或Matriderm™。根据至少一种美学指标，与对照相比，11项比较研究中有5项显示ADM具有更好的美学效果。而6/11显示ADM具有更好的功能结果。与常规实践相比，没有研究显示ADM具有较差的美学或功能结果。
结论：总之，缺乏报告与传统做法相比效果较差的研究，和对他们有利的累积效应方向，提供强有力的适应症以支持AlloDerm™的使用，Integra™,或Matriderm™移植物。进一步的比较研究，包括RCT,需要加强这些初步迹象。
