目的:评价人工真皮治疗伴有骨或肌腱外露的皮肤软组织缺损的临床效果。
方法:回顾性分析福建省立医院创伤外科2018年2月至2020年8月收治的45例皮肤软组织缺损伴骨或肌腱外露患者的临床资料。将其分为人工真皮组和对照组。使用温哥华疤痕量表(mVSS)评估伤口,记录术后3、6、9、12个月的视觉模拟评分(VAS)。手术后12个月,使用英国医学研究理事会(BMRC)的标准评估皮肤感觉恢复情况.
结果:病例包括男26例,女19例,50至85岁。所有患者随访12~18个月,平均13.8个月。与对照组相比,观察组创面愈合时间较长(35.8±10.6vs.28.5±4.8,P=0.007),手术次数和住院时间没有显着差异。mVSS评分组间无差异(P=0.294),但分数随时间下降(Ptime<0.001),组×时间交互作用显著(P交互作用<0.001)。同样,组间VAS评分无差异(P=0.667),但得分随时间降低(Ptime<0.001);组×时间交互作用不显著(P交互作用=0.274)。在手术后的12个月大关,在人造真皮组中,23例患者MCRR评分为S3+,而两名患者的S0至S3不等;在对照组中,在17例患者中观察到S3+,和S0-S3三者(P=0.815)。
结论:对于不能耐受或不愿意进行自体皮瓣移植的皮肤软组织缺损伴骨或肌腱外露患者,人工真皮治疗被认为是一种安全有效的替代疗法。它提供了最小的供体部位创伤的优点,操作简单,术后功能恢复良好。
OBJECTIVE: The clinical effects of artificial dermis in treating skin and soft tissue defects accompanied by bone or tendon exposure were assessed.
METHODS: A retrospective analysis was conducted on the clinical data of 45 cases of skin and soft tissue defects accompanied by bone or tendon exposure admitted to the trauma surgery department of Fujian Provincial Hospital between February 2018 and August 2020. They were divided into the artificial dermis and control groups. The wound was assessed using the Vancouver Scar Scale (mVSS), and the postoperative visual analogue scale (VAS) scores were recorded at 3, 6, 9, and 12 months after surgery. At the 12-month after surgery, skin sensation recovery was evaluated using the criteria of the British Medical Research Council (BMRC).
RESULTS: The cases included 26 males and 19 females, aged 50 to 85 years. All patients were followed up for an average of 13.8 months (range: 12-18 months). Compared with controls, the wound healing time of the observation group was longer (35.8 ± 10.6 vs. 28.5 ± 4.8, P = 0.007), without significant differences for the number of operations and length of hospitalization. The mVSS scores were not different between groups (Pgroup = 0.294), but the scores decreased with time (Ptime < 0.001), and the group×time interaction was significant (Pinteraction < 0.001). Similarly, the VAS scores were not different between groups (Pgroup = 0.667), but the scores decreased with time (Ptime < 0.001); the group×time interaction was not significant (Pinteraction = 0.274). At the 12-month mark following the operation, in the artificial dermis group, the MCRR score was S3+ in 23 patients, while it ranged from S0 to S3 in two patients; in the control group, S3+ was observed in 17 patients, and S0-S3 in three (P = 0.815).
CONCLUSIONS: Artificial dermis treatment is considered a safe and effective alternative therapy for patients with skin and soft tissue defects accompanied by bone or tendon exposure who cannot tolerate or are unwilling to undergo autologous skin flap transplantation. It offers the advantages of minimal donor site trauma, simplicity in operation, and favorable postoperative functional recovery.