Department of Burns, Beijing Jishuitan Hospital, Beijing 100035, PR China.
J Plast Reconstr Aesthet Surg. 2010 Jun;63(6):e512-8. doi: 10.1016/j.bjps.2009.11.004. Epub 2009 Dec 9.
The task of managing an open wound complicated by exposed bony structures underneath is difficult, if not challenging. We have instituted a method of managing the problems in stages using an artificial dermis and skin grafting technique in 17 wounds in 15 individuals from Sept. 2006 to Feb. 2009. While all wounds were noted to assume aberrant healing processes, the majority of involved bony structures were devoid of periosteal covering compounded by various degrees of infection. Of 15 incidents, mechanical trauma was responsible for 10, chemical burns for two and electrical burns for two patients. A chronic non-healing ulcer with exposed bone formed in an old burn scar accounted for the remaining one. The regimen of surgical management consisted of initial debridement, the coverage of the resultant wound with an artificial dermis and a partial-thickness skin grafted over this dermis-like structure grown with granulation tissues. Complete wound healing was attained in 15 out of 17 with outstanding cosmetic and minimal donor-site morbidity. Despite initial failure encountered in two, the morbidities noted were low. It is especially useful in large defects that usually require flaps for coverage.
处理伴有骨外露的开放性创伤是一项艰巨的任务，如果不具有挑战性的话。自 2006 年 9 月至 2009 年 2 月，我们采用人工真皮和皮肤移植技术分期处理了 15 名患者的 17 处创伤。虽然所有的伤口都出现了异常愈合过程，但大多数受累的骨结构都没有骨膜覆盖，且伴有不同程度的感染。在 15 个病例中，机械性创伤导致 10 例，化学烧伤导致 2 例，电烧伤导致 2 例。在一处陈旧性烧伤瘢痕上形成了慢性不愈合溃疡伴骨外露，这是唯一的例外。手术治疗方案包括初期清创，用人工真皮覆盖由此产生的伤口，然后在这种真皮样结构上移植部分厚度的皮肤，使其与肉芽组织一起生长。在 17 处伤口中，有 15 处完全愈合，外观和供区并发症都很少。尽管有 2 例最初失败，但并发症发生率较低。它在通常需要皮瓣覆盖的大面积缺损中特别有用。
