Atlan M, Naouri M, Lorette G, Estève E, Zakine G
Service de chirurgie plastique reconstructrice et esthétique, hôpital Trousseau, faculté de médecine François-Rabelais, CHRU de Tours, 37044 Tours cedex 9, France.
Ann Chir Plast Esthet. 2011 Apr;56(2):163-9. doi: 10.1016/j.anplas.2009.11.013. Epub 2010 Jun 17.
Constitutional painful callosities is an unusual pathology, integrated in the frame of "palmoplantar keratodermia" (PPK). Lesions are located at areas of support of the sole. These lesions are painful and disable the normal walking. Treatments are suspensive and painkillers. We report our experience of a single surgical treatment: surgical excision, split thickness skin graft applied on a dermal substitute and secured by negative wound therapy. A 28-year-old patient, affected by this disease, has a desire of pregnancy but her treatment is highly teratogen. A year post-op, wounds were healed. The walk was possible with a relief of the pain, without any ulcerations. The surgical treatment by excision and graft or flaps was previously reported for PPK. The use of dermal substitute was never described for this indication. Dermal substitute compensate the thickness of the soft tissue defect and give an accurate quality of elasticity in this localisation .The negative wound therapy enhances the quality and shortens the length of graft taking, and the adhesion of the dermal substitute on his bed.
先天性疼痛性胼胝是一种罕见的病理情况，属于“掌跖角化病”（PPK）范畴。病变位于足底支撑部位。这些病变会引起疼痛，影响正常行走。治疗方法包括暂停治疗和使用止痛药。我们报告了一例单一手术治疗的经验：手术切除，在真皮替代物上应用分层皮片移植，并通过负压伤口治疗固定。一名28岁患有此病的患者有怀孕意愿，但她的治疗具有高度致畸性。术后一年，伤口愈合。患者能够行走，疼痛减轻，且无任何溃疡。此前已有关于PPK手术切除及移植或皮瓣治疗的报道。但从未有过针对该适应症使用真皮替代物的描述。真皮替代物可弥补软组织缺损的厚度，并在该部位提供准确的弹性质量。负压伤口治疗可提高质量，缩短移植皮片的成活时间，并增强真皮替代物与创面的粘连。
