Royal Free Hospital, Hampstead, London NW3 2QG, UK.
J Plast Reconstr Aesthet Surg. 2010 Sep;63(9):1534-7. doi: 10.1016/j.bjps.2009.09.008. Epub 2009 Oct 22.
A skin graft is the simplest way to reconstruct an area of skin loss. To improve the chance of successful take, shearing forces and haematoma formation between the bed and the graft must be reduced. To achieve this, many surgeons use a tie-over dressing to secure the graft. However, 'quilting' the graft to the wound bed is an alternative method for securing grafts which may be superior to tie-over dressings. The purpose of this study was to compare the outcome of securing a full thickness graft by tie-over dressing versus quilting in the hand. To do this, we performed a retrospective review of graft-take in a consecutive series of 40 patients undergoing dermofasciectomy for Dupuytren's disease over a five year period. Our results demonstrate no significant difference in graft-take comparing grafts secured with a tie-over dressing or by quilting. Importantly, there were no cases of injury to the tendons or neurovascular structures in those cases where the graft was secured by quilting. Our technique for securing the graft by quilting is less time-consuming compared with a tie-over dressing. Therefore, we no longer use tie-over dressings to secure full-thickness grafts in the hand.
皮肤移植是重建皮肤缺失区域的最简单方法。为了提高成功移植的机会，必须减少床与移植物之间的剪切力和血肿形成。为了实现这一点，许多外科医生使用加压包扎来固定移植物。然而，将移植物“绗缝”到伤口床上是一种固定移植物的替代方法，它可能优于加压包扎。本研究的目的是比较在手部分别使用加压包扎和绗缝固定全厚移植物的效果。为此，我们对 5 年内因掌腱膜挛缩症而行皮瓣筋膜切除术的 40 例连续患者的移植物成活率进行了回顾性研究。我们的结果表明，加压包扎和绗缝固定的移植物成活率无显著差异。重要的是，在使用绗缝固定移植物的情况下，没有发生肌腱或神经血管结构损伤的病例。与加压包扎相比，我们使用绗缝固定移植物的技术耗时更少。因此，我们在手部不再使用加压包扎来固定全厚移植物。
