Beck B W, Nagy D, Goldberg J S
Department of Oral and Maxillofacial Surgery, Case Western Reserve University, University Hospitals and Mt. Sinai Medical Center of Cleveland, OH, USA.
J Oral Maxillofac Surg. 1999 Aug;57(8):930-4; discussion 934-5. doi: 10.1016/s0278-2391(99)90011-3.
The purpose of our study was to compare the healing characteristics of two common techniques of obtaining a dermal graft and the patient's perception of the aesthetics of the donor site scar.
Fifty-two female patients (60 sites) were evaluated by means of questionnaire, interview, and chart review. The mean follow-up time was 4.08 years after temporomandibular joint reconstructive surgery. Comparisons were made between the two primary harvest techniques: the dermatome (trapdoor) and the elliptical excision methods. Of the 60 sites, 32 involved the elliptical method and 28 the trapdoor method.
Common findings in both groups included prolonged discomfort (6.6%), altered contour (50%), color change (58.3%), prolonged numbness (10%), and itching (21.6%). There were few healing complications (5.0%). Aesthetically, 45% of patients thought their scars were noticeable, and 8.3% thought that they were bothersome. The elliptical method showed significantly less discomfort, texture change, numbness, and itching. The scars were concealed better and less noticeable. Although 60.7% of the patients with the trapdoor method considered the wounds to be noticeable, only four patients reported that the scars were bothersome.
Both techniques were used successfully with minimal complications. Although the elliptical technique appeared to have cosmetic advantages, larger grafts produced longer wounds, which may be more difficult to conceal. The trapdoor method is a simple technique that is used effectively with good patient acceptance. The results of this study are useful in properly informing patients about what to expect after having a dermal graft.
我们研究的目的是比较获取真皮移植物的两种常用技术的愈合特征以及患者对供区瘢痕美学效果的看法。
通过问卷调查、访谈和病历回顾对52例女性患者（60个部位）进行评估。颞下颌关节重建手术后的平均随访时间为4.08年。对两种主要的取材技术进行比较：取皮刀（活板门）法和椭圆形切除法。在60个部位中，32个采用椭圆形法，28个采用活板门法。
两组的常见表现包括不适时间延长（6.6%）、外形改变（50%）、颜色改变（58.3%）、麻木时间延长（10%）和瘙痒（21.6%）。愈合并发症较少（5.0%）。在美学方面，45%的患者认为他们的瘢痕明显，8.3%的患者认为瘢痕令人困扰。椭圆形法的不适、质地改变、麻木和瘙痒明显较少。瘢痕隐藏得更好且不太明显。虽然采用活板门法的患者中有60.7%认为伤口明显，但只有4例患者报告瘢痕令人困扰。
两种技术均成功应用，并发症极少。虽然椭圆形技术似乎具有美容优势，但更大的移植物会产生更长的伤口，可能更难隐藏。活板门法是一种简单的技术，患者接受度良好且应用有效。本研究结果有助于让患者正确了解进行真皮移植后可能出现的情况。
