Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Dermatol Ther. 2020 Nov;33(6):e14466. doi: 10.1111/dth.14466. Epub 2020 Nov 18.
Hand burns are frequently seen in children, often resulting in digital flexion contractures. Traditional split-thickness or full-thickness skin grafts leave notably different skin texture and hyperpigmentation. The purpose of this study was to describe our operation for treating digital flexion contractures with full-thickness plantar skin grafts, and to evaluate the appearance and function outcomes. Hematoxylin and eosin staining, Masson trichrome staining and Melan A (marker of melanocyte) staining were used to evaluate palmar skin, plantar skin, groin skin and burn scars. Full-thickness plantar skin grafts were performed between 2008 and 2015 in 24 hand burn patients with digital flexion contracture. The average age at the time of surgery was 39.3 months and the average follow-up period was 5.5 years. The functional and cosmetic results were assessed. Plantar skin shared similar attributes with palmar skin histologically. Both plantar skin and palmar skin did not express melan A. All of the skin grafts survived well without hematoma, infection and necrosis. The grafts resembled the adjacent normal skin in regards to appearance and texture. The average TAM (total active movement) degree for the fingers was improved from 152.3° to 238.5°. The average VSS (Vancouver Scar Scale) score decreased dramatically from 10.4 to 1.1. Twenty one of twenty four patients (21/24, 87.5%) were very satisfied with function and appearance, and three in twenty four (3/24, 12.5%) were somewhat satisfied. This study indicates that full-thickness plantar skin grafts can achieve a satisfactory appearance and good function for hand burn child patients with digital flexion contractures.
手烧伤在儿童中很常见，常导致手指屈曲挛缩。传统的断层或全厚皮片移植会导致明显不同的皮肤质地和色素沉着过度。本研究旨在描述我们采用足底全厚皮片移植治疗手指屈曲挛缩的手术方法，并评估其外观和功能效果。采用苏木精-伊红染色、Masson 三色染色和 Melan A（黑素细胞标志物）染色来评估掌侧皮肤、足底皮肤、腹股沟皮肤和烧伤瘢痕。2008 年至 2015 年间，我们对 24 例手指屈曲挛缩的手烧伤患者进行了足底全厚皮片移植。手术时的平均年龄为 39.3 个月，平均随访时间为 5.5 年。评估了功能和美容结果。足底皮片在组织学上与掌侧皮片具有相似的特性。足底皮片和掌侧皮片均不表达 Melan A。所有皮片均无血肿、感染和坏死，均存活良好。移植皮片在外观和质地方面与邻近正常皮肤相似。手指的平均 TAM（总主动活动度）从 152.3°提高到 238.5°。Vancouver 瘢痕量表（VSS）评分从 10.4 分显著降低至 1.1 分。24 例患者中有 21 例（21/24，87.5%）对功能和外观非常满意，24 例中有 3 例（3/24，12.5%）较为满意。本研究表明，足底全厚皮片移植可为手烧伤儿童手指屈曲挛缩患者提供满意的外观和良好的功能。
