Chung Bryan, O'Mahony Gavin D, Lam Gretl, Chiu David T W
New York, N.Y.; and Oklahoma City, Okla.
From the Institute of Reconstructive Plastic Surgery, New York University Hand Service, New York University Langone Medical Center; and the Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma Health Sciences Center.
Plast Reconstr Surg. 2017 Sep;140(3):593-598. doi: 10.1097/PRS.0000000000003623.
Composite grafts consisting of adipose tissue and skin have been reported in the literature but have been restricted to areas smaller than 4 to 5 cm. The senior author (D.T.W.C.) has developed a technique of adipose tissue-preserved full-thickness skin grafts for larger areas with success similar to that achieved with conventional full-thickness skin grafts.
All cases of the senior author involving a full-thickness skin graft were identified and reviewed to identify cases in which adipose tissue-preserved full-thickness skin grafts were used. Indication for skin grafting, anatomical location of recipient and donor sites, size of graft, total number of grafts received by each patient, and percentage take were extracted from patient charts. Graft take was measured between days 5 and 14.
A total of 72 adipose tissue-preserved skin grafts on 47 patients were identified from 1994 to 2009, with a median follow-up of 8 years. The size of defect ranged from 0.7 to 210 cm, with a median area of 6 cm (interquartile range, 2.5 to 15 cm). Only six of 72 grafts were found to have less than 100 percent take. The lowest take percentage was 85 percent in a graft with an area of 2.6 cm. There were no graft failures.
This study confirms the proof-of-concept that both larger and distant donor- site adipose tissue-preserved skin grafts are a viable alternative to conventional defatted full-thickness skin grafting. It appears that there is a low complication rate with respect to graft failure or incomplete graft take.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
文献中已报道了由脂肪组织和皮肤组成的复合移植物，但仅限于面积小于4至5厘米的区域。资深作者（D.T.W.C.）已开发出一种用于较大面积的保留脂肪组织的全厚皮肤移植技术，其成功率与传统全厚皮肤移植相似。
对资深作者所有涉及全厚皮肤移植的病例进行识别和回顾，以确定使用保留脂肪组织的全厚皮肤移植的病例。从患者病历中提取皮肤移植的指征、受区和供区的解剖位置、移植物大小、每位患者接受的移植物总数以及移植成活率。在第5至14天测量移植成活率。
1994年至2009年共识别出47例患者的72块保留脂肪组织的皮肤移植物，中位随访时间为8年。缺损面积范围为0.7至210平方厘米，中位面积为6平方厘米（四分位间距，2.5至15平方厘米）。72块移植物中只有6块的移植成活率低于100%。面积为2.6平方厘米的一块移植物的最低成活率为85%。没有移植物失败的情况。
本研究证实了这样一个概念验证，即更大面积和距离更远的供区保留脂肪组织的皮肤移植是传统脱脂全厚皮肤移植的可行替代方法。看来移植物失败或移植不完全的并发症发生率较低。
临床问题/证据水平：治疗性，IV级。
