人工真皮联合自体薄层皮片移植修复难愈性创面的疗效观察

摘要

Objective To observe the effects of artificial dermis combined with autologous thin layer skin grafts(composite skin) in repairing the refractory wounds.Methods Thirty patients with refractory wounds were in-volved who had deep skin soft tissue defect , some cases complicated with exposure of muscles , tendons, bone.All of refractory wounds were repaired by the technology of combining artificial dermis with autologous thin skin transplanta -tion.The technology included 2 steps:firstly, artificial dermis were transplanted on all refractory wounds after the de-bridement , then autologous thin layer skin were transplanted on artificial dermis 2~3 weeks after debridement , at that time the dermal tissue growing well and covering exposed tendon , bone tissue .Then the survival rate of artificial dermis and composite skin , the degree of scar hyperplasia , pigmentation change and joint activity were observed to e-valuate the effects of composite skin repairing refractory wounds .Results In 25 of 30 patients artificial dermis were survival after transplantation,the survival rate was 83.3%(25/30), the causes of 5 cases failure included local infec-tion 4 cases and instability separately 1 case.The survival rate of composite skin was 100.0%(25/25).The compos-ite skin showed smooth and flexible , no obvious change of scar hyperplasia and pigment on the area of composite skin and doner skin during of follow-up 2~6 months after discharge .Conclusion The advantages of composite skin graft-ing were included high survival rate and well texture , no significant change of scar hyperplasia and pigment on the ar-ea of composite skin and doner skin , easily operation .%目的：观察人工真皮联合自体薄层皮片移植（简称复合皮移植）修复难愈性创面的疗效。方法选取住院的各种难愈性创面患者30例，均存在各种原因导致的不同程度和部位皮肤软组织缺损创面，部分病例伴有肌肉、肌腱、骨外露。一期清创后移植人工真皮，2～3周后局部肉芽组织生长良好，外露肌腱和骨组织被类真皮组织覆盖，二期移植自体薄层皮片。观察人工真皮和自体薄层皮片（复合皮）移植成活率、瘢痕增生、色素沉着和关节活动度等情况，综合评价人工真皮联合自体薄层皮片移植修复难愈性创面的临床效果。结果30例患者人工真皮移植后成活25例，成活率为83.3％；5例溶解失活，原因为局部感染4例，局部固定不良1例。存活的25例人工真皮联合自体薄层皮片移植成活率达100.0％。25例出院后均随访2～6个月，复合皮生长良好，光滑有弹性，无明显瘢痕增生，少量皮肤色泽改变；供皮部位恢复良好，无瘢痕增生，部分患者有少量色素改变。结论人工真皮联合自体薄层皮片移植修复难愈性创面，复合皮移植成活率高，创面愈合质量好，成活后的复合皮部位和供皮区瘢痕增生轻微，关节功能恢复良好，方法简便，为难愈性创面的修复提供了新选择。