Moazzam A, Gordon D J
Northern Ireland Plastic and Maxillofacial Service, Ulster Hospital Dundonald, Belfast, Northern Ireland, UK.
Br J Plast Surg. 2003 Oct;56(7):695-700. doi: 10.1016/s0007-1226(03)00213-3.
Direct closure of a full thickness skin defect by suturing is the simplest and best solution in most cases. When suturing is not possible, then a skin graft may be the next choice for reconstruction. It is usual for the graft to be applied to the unaltered defect, accepting the size of the wound as the area to be grafted. This approach ignores the potential contribution of the elastic properties of the wound edges, which are so readily used to advantage in direct closure. A simple technique, which makes skin defects substantially smaller prior to skin grafting, is described. This technique benefits the primary defect by minimising the area of scar produced, as well as minimising the size of skin graft required and thus the graft donor site. The secondary defect of the radial forearm flap was used as a model wound in a prospective randomised trial to assess the use of this technique. Twenty successive patients undergoing free radial forearm flap surgery were entered into the trial. The technique consisted of preliminary cross-suturing of the wound prior to skin grafting. Half of the cases received cross-wound suturing and half of the cases had grafts applied to the unaltered area of the defect. Measurements of the forearm flap donor defects were taken using templates made at the time of surgery and at later intervals. A statistically significant reduction in the flap donor defects was achieved using the cross-suturing technique. Fewer complications such as skin graft failure and tendon adherence to graft were seen with the new technique. This technique is recommended not only for minimising morbidity in the radial forearm flap donor site, but also for reducing the size of any full thickness skin defect prior to skin grafting.
在大多数情况下，通过缝合直接闭合全层皮肤缺损是最简单且最佳的解决方案。当无法进行缝合时，皮肤移植可能是重建的下一个选择。通常将移植物应用于未改变的缺损处，将伤口大小作为要移植的面积。这种方法忽略了伤口边缘弹性特性的潜在作用，而这种特性在直接闭合中很容易被利用。本文描述了一种在皮肤移植前使皮肤缺损显著变小的简单技术。该技术通过最小化产生的瘢痕面积，以及最小化所需皮肤移植物的大小从而减小移植物供区，使原发性缺损受益。在前瞻性随机试验中，将桡侧前臂皮瓣的继发性缺损用作模型伤口来评估该技术的应用。连续20例接受游离桡侧前臂皮瓣手术的患者进入该试验。该技术包括在皮肤移植前对伤口进行初步交叉缝合。一半病例接受交叉伤口缝合，另一半病例将移植物应用于缺损的未改变区域。使用手术时制作的模板以及之后的不同时间间隔对前臂皮瓣供区缺损进行测量。使用交叉缝合技术使皮瓣供区缺损有统计学意义的减小。新技术出现皮肤移植失败和肌腱与移植物粘连等并发症较少。推荐该技术不仅用于最小化桡侧前臂皮瓣供区的发病率，还用于在皮肤移植前减小任何全层皮肤缺损的大小。
