Department of Plastic Surgery, Medical School, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Periferiaki Odos, N. Efkarpia, 54603, Thessaloniki, Greece,
Arch Orthop Trauma Surg. 2013 Nov;133(11):1521-6. doi: 10.1007/s00402-013-1834-2. Epub 2013 Aug 21.
Management of skin avulsion injuries of the upper extremity may require coverage with large flaps or skin autografts. Cutaneous grafting is frequently combined with artificial skin to optimize the final functional and cosmetic result. The conventional use of bilaminated dermal substitutes consists of a two-stage procedure and requires long immobilization of the operated area. The purpose of this retrospective study is to evaluate the impact of a dermal regeneration template immediately covered by skin grafts in a one-step procedure for reconstructing skin avulsion injuries of the hand and forearm.
We performed this technique in eight patients who presented with extended skin defects of the hand and forearm following skin avulsion injuries. Dimensions of the defects ranged from 160 to 1,250 cm(2). After debridement, Integra(®) Single Layer was applied and covered with unmeshed thin skin autografts; compressive dressings were used for 1 week and mobilization started by the second postoperative week. Histological examination of the grafted areas was performed 2 weeks after surgery. Functional and cosmetic outcome was assessed 12 months postoperatively.
The overall take rate of the dermal substitute and skin graft was 95-98 %. Histological results showed complete incorporation and vascular proliferation of the template, which allowed the neo-vascularization of the overlying autograft. The mean grip strength of the operated hands was at the 83 % of the normal contralateral hands. Pliability and overall appearance of the reconstructed areas was satisfactory (mean Vancouver Scar Scale Score 1.875).
The use of Integra(®) Single Layer dermal substitute and immediate skin overgrafting consists an alternative reconstructive option for managing extended skin avulsion injuries of the upper extremity; it reduces postoperative immobilization, minimizes donor site morbidity and provides good functional and esthetic results in a single surgical procedure.
上肢皮肤撕脱伤的处理可能需要用大型皮瓣或自体皮移植来覆盖。皮片移植通常与人工皮结合使用，以优化最终的功能和美容效果。传统的双层真皮替代物的使用包括两阶段的程序，并且需要对手术区域进行长时间的固定。本回顾性研究的目的是评估在一步法中使用真皮再生模板覆盖即刻皮片移植治疗手部和前臂皮肤撕脱伤的效果。
我们对 8 例手部和前臂皮肤撕脱伤后出现广泛皮肤缺损的患者采用了这种技术。缺损的尺寸范围从 160 到 1250cm²。清创后，应用 Integra®单层，并用非网孔状薄自体皮移植覆盖；用加压敷料包扎 1 周，术后第 2 周开始活动。术后 2 周对移植区域进行组织学检查。术后 12 个月评估功能和美容效果。
真皮替代物和皮片的总成活率为 95-98%。组织学结果显示模板完全整合和血管增生，允许覆盖的自体皮的新生血管化。手术手的平均握力为正常对侧手的 83%。重建区域的柔韧性和整体外观令人满意（平均温哥华瘢痕量表评分为 1.875）。
使用 Integra®单层真皮替代物和即刻皮片覆盖是治疗上肢广泛皮肤撕脱伤的另一种重建选择；它减少了术后固定时间，最大限度地减少了供区的发病率，并在单一手术中提供了良好的功能和美容效果。
