Bechara Falk G, Sand Michael, Radenhausen Michael, Sand Daniel, Moussa Georg, Gambichler Thilo, Altmeyer Peter, Hoffmann Klaus
Department of Dermatology and Allergology, Ruhr-University Bochum, Bochum, Germany.
Dermatol Surg. 2006 Mar;32(3):353-8. doi: 10.1111/j.1524-4725.2006.32072.x.
Skin grafting is a common procedure to close defects after tumor resection. However, delicate areas such as the heel or the sole of the foot can be closed with a specially designed graft as described in this article.
To describe a surgical technique by means of erbium:YAG laser-assisted preparation of a combined dermal/full-thickness sandwich skin graft that facilitates the closure of defects, especially at mechanically stressed anatomic sites.
Tumor defects on the sole of the foot of 28 patients were closed with a new dermal/full-thickness sandwich skin graft. To obtain this special graft, half of a full-thickness skin graft twice the size of the wound defect was deepithelialized with an erbium:YAG laser. After complete defatting of the transplant, the deepithelialized part was folded beneath the full-thickness part (upside down) resulting in a sandwich graft, enabling contact of the papillary dermis with the wound surface. Graft results were graded as excellent when more than 75%, good if 50-75%, fair if 25-50%, and poor if less than 25% of the transplant healed.
Results were graded as excellent in 32%, good in 54%, fair in 11%, and poor in 3% of the patients. Total graft loss was experienced in 1 of 28 patients. Complications such as bulky margins or infection were encountered in 14% of the patients.
The laser-assisted preparation of the combined dermal/full-thickness sandwich skin graft is a new technique that facilitates the closure of defects in delicate anatomic locations with high mechanical stress like the plantar sole.
皮肤移植是肿瘤切除后闭合缺损的常用手术方法。然而，像足跟或足底等精细部位可用本文所述的特殊设计的移植物进行闭合。
描述一种通过铒：钇铝石榴石激光辅助制备真皮/全层三明治皮肤移植物的手术技术，该技术有助于闭合缺损，尤其是在机械应力较大的解剖部位。
用一种新型真皮/全层三明治皮肤移植物闭合28例患者足底的肿瘤缺损。为获得这种特殊移植物，取一块面积为伤口缺损两倍大小的全层皮肤移植物的一半，用铒：钇铝石榴石激光进行去上皮处理。在移植物完全脱脂后，将去上皮部分（翻转）折叠在全层部分下方，形成三明治移植物，使乳头层真皮与创面接触。移植物结果分级为：愈合超过75%为优秀，50%-75%为良好，25%-50%为中等，低于25%为差。
32%的患者结果分级为优秀，54%为良好，11%为中等，3%为差。28例患者中有1例出现移植物完全丢失。14%的患者出现诸如边缘臃肿或感染等并发症。
激光辅助制备真皮/全层三明治皮肤移植物是一种新技术，有助于闭合足底等机械应力高的精细解剖部位的缺损。
