Taras John S, Sapienza Anthony, Roach Josh B, Taras John P
Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
J Hand Surg Am. 2010 Mar;35(3):415-21. doi: 10.1016/j.jhsa.2009.12.008. Epub 2010 Feb 9.
Trauma to the digits often leaves soft tissue defects with exposed bone, joint, and/or tendon that require soft tissue replacement. The objective of this study was to evaluate the effectiveness of acellular dermal regeneration template combined with full-thickness skin grafting for soft tissue reconstruction in digital injuries with soft tissue defects.
Acellular dermal regeneration template was used to reconstruct digital injuries with exposed bone, joint, tendon, and/or hardware not amenable to treatment with healing by secondary intention, rotation flaps, or primary skin grafts. Acellular dermal regeneration template was applied to 21 digits in 17 patients. Nineteen digits had exposed bone, 8 digits had exposed tendon, 6 digits had exposed joints, and 2 digits had exposed hardware. The acellular dermal regeneration template was sutured over the soft tissue defect. Over 3 weeks, a neodermis formed. The superficial silicone layer of the acellular dermal regeneration template was removed, and the digits received full-thickness epidermal autografting with cotton bolster.
The duration of postoperative follow-up extended to a minimum of 12 months. For the injury sites where acellular dermal regeneration template was applied, the total area of application ranged from 1 cm(2) to 24 cm(2), with the largest individual site measuring 12 cm(2). Twenty of 21 digits demonstrated 100% incorporation of the acellular dermal regeneration template skin substitute. One digit that had sustained multilevel trauma developed necrosis requiring revision amputation. Full-thickness epidermal autografting was performed an average of 24 days after acellular dermal regeneration template skin substitute application and demonstrated a 100% take in 16 of 20 digits and partial graft loss of 15% to 25% in 4 of 20 digits that did not require further treatment.
Acellular dermal regeneration template combined with secondary full-thickness skin grafting is an effective method of skin reconstruction in complex digital injuries with soft tissue defects involving exposed bone, tendon, and joint. The neodermis increases tissue bulk and facilitates epidermal autografting with digital injuries that otherwise would require flap coverage or skeletal shortening of the digit.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
手指创伤常导致软组织缺损，伴有骨骼、关节和/或肌腱外露，需要进行软组织修复。本研究的目的是评估脱细胞真皮再生模板联合全厚皮片移植在伴有软组织缺损的手指损伤软组织重建中的有效性。
采用脱细胞真皮再生模板修复伴有骨骼、关节、肌腱和/或内固定物外露且不适合二期愈合、旋转皮瓣或一期皮片移植治疗的手指损伤。将脱细胞真皮再生模板应用于17例患者的21根手指。19根手指有骨骼外露，8根手指有肌腱外露，6根手指有关节外露，2根手指有内固定物外露。将脱细胞真皮再生模板缝合于软组织缺损处。3周内形成新真皮。去除脱细胞真皮再生模板的表层硅胶层，手指接受带棉垫的全厚自体表皮移植。
术后随访时间至少延长至12个月。对于应用脱细胞真皮再生模板的损伤部位，应用总面积为1 cm²至24 cm²，最大单个部位为12 cm²。21根手指中有20根显示脱细胞真皮再生模板皮肤替代物100%融合。1根遭受多处创伤的手指发生坏死，需要行翻修截肢术。在应用脱细胞真皮再生模板皮肤替代物后平均24天进行全厚自体表皮移植，20根手指中有16根移植皮片100%存活，20根手指中有4根未进一步治疗的移植皮片部分丢失15%至25%。
脱细胞真皮再生模板联合二期全厚皮片移植是修复伴有软组织缺损、涉及骨骼、肌腱和关节外露的复杂手指损伤的有效皮肤重建方法。新真皮增加了组织体积，便于对原本需要皮瓣覆盖或手指骨骼缩短的手指损伤进行自体表皮移植。
研究类型/证据水平：治疗性IV级。
