背景:很少进行研究来探索Integra®真皮再生模板(IDRT)与延迟的分裂厚度皮肤移植物(STSG)结合用于重建复杂的背侧手的实用性,数字,拇指受伤。这项研究报告了通过两阶段过程使用该技术治疗的14名患者的适应症和结果。
方法:我们回顾性回顾了2015年5月至2018年10月接受IDRT联合STSG治疗的所有患者。纳入标准为手背的创伤或感染后软组织缺损(STDs),手指,和拇指,不适合直接闭合伤口,需要局部伤口,椎弓根,或游离皮瓣重建。清创术后,采用了两阶段程序,即IDRT后跟STSG。指示,功能结果,美学结果,并发症,患者满意度,使用标准化仪器在36个月的随访中评估了STSG的服用率。
结果:共纳入14例15例重建患者(平均年龄=48岁)。50%的病例涉及优势手。背部性病涉及手,手指,拇指,7、3、2和2例中的手和拇指,分别。平均STD尺寸为35cm2(范围:3-150cm2)。伤口与暴露的肌腱有关(没有腹膜),骨(无骨膜),和关节(无胶囊)的8例(57%)。IDRT/STSG采取率为97%。温哥华疤痕量表的平均得分为2(1-4)。
结论:36个月的随访表明,IDRT是一种安全可靠的技术,可以被认为是治疗部分患者创伤性性病的皮瓣重建的可行替代方法。美学结果是可以接受的,手指的功能恢复非常好,患者满意度很高,并发症发生率很低。
BACKGROUND: Few studies have been conducted to explore the utility of the Integra® dermal regeneration template (IDRT) combined with a delayed split-thickness skin graft (STSG) for reconstructing complex dorsal hand, digit, and thumb injuries. This study reports the indications and outcomes for 14 patients treated with this technique via a two-stage process.
METHODS: We retrospectively reviewed all patients treated by IDRT combined with STSG from May 2015 to October 2018. The inclusion criterion was traumatic or post-infectious soft tissue defects (STDs) of the dorsal hand, fingers, and thumb, not suitable for direct wound closure and requiring local, pedicle, or free flap reconstruction. After debridement, a two-stage procedure was applied, namely IDRT followed by STSG. Indications, functional outcomes, aesthetic results, complications, patient satisfaction, and the STSG take rate were evaluated over a 36-month follow-up using standardised instruments.
RESULTS: A total of 14 patients with 15 reconstructions (average age = 48 years) were included. The dominant hand was involved in 50% of cases. Dorsal STDs involved the hand, fingers, thumb, and hand and thumb in 7, 3, 2 and 2 cases, respectively. The mean STD size was 35 cm2 (range: 3-150 cm2). The wound was associated with exposed tendons (without peritenon), bone (without periosteum), and joints (without a capsule) in eight cases (57%). The IDRT/STSG take rate was 97%. The average Vancouver Scar Scale score was 2 (1-4).
CONCLUSIONS: The 36-month follow-up demonstrated that IDRT is a safe and reliable technique that can be considered a viable alternative to flap reconstruction for the management of traumatic STDs in selected patients. The aesthetic outcomes are acceptable, functional recovery of the fingers is excellent, patient satisfaction is very high and the rate of complications is very low.