Cooper Laura, Gronet Edward, Carlsson Anders, Chan Rodney
Department of Surgery, University of Maryland Medical Center, Baltimore, Md.
STARS Plastic Surgery, San Antonio, Tex.
Plast Reconstr Surg Glob Open. 2020 Dec 18;8(12):e3304. doi: 10.1097/GOX.0000000000003304. eCollection 2020 Dec.
Split-thickness skin graft has been the standard in the coverage of large full-thickness skin defects. However, donor sites can be associated with significant pain and scarring. Further, the recipient sites frequently lack some basic skin functions, such as temperature regulation, uniform texture, appropriate color, normal pliability, elasticity, and lubrication. Full-thickness skin grafts, while able to more adequately recapitulate skin function, have even greater donor site requirements. Implantation of full-thickness skin micro-columns is a relatively novel concept in which the skin is harvested orthogonally rather than tangentially. These micro-columns contain elements of full-thickness skin grafts, including reticular dermal fibroblasts, hair follicles, skin adnexa, and adipose tissue-all elements that contribute to skin function. Notably, it has been shown that the diameter of the skin micro-columns determine donor site morbidity; however, in most cases, full-thickness skin micro-column harvest results in a trivial donor site far less invasive or morbid than a traditional full-thickness skin graft or split-thickness skin graft harvest. Here, we present 2 cases in which full-thickness skin micro-columns were harvested and implanted into a bilayer dermal regeneration matrix (Integra) to achieve durable single-stage skin replacement with practically no donor site morbidity.
断层皮片移植一直是大面积全层皮肤缺损覆盖的标准方法。然而，供皮区可能会伴有明显的疼痛和瘢痕形成。此外，受皮区常常缺乏一些基本的皮肤功能，如温度调节、质地均匀、颜色适宜、正常的柔韧性、弹性和润滑性。全厚皮片移植虽然能够更充分地重现皮肤功能，但对供皮区的要求更高。全厚皮肤微柱植入是一个相对新颖的概念，即皮肤是垂直而非切线方向获取的。这些微柱包含全厚皮片移植的成分，包括网状真皮成纤维细胞、毛囊、皮肤附属器和脂肪组织——所有这些成分都有助于皮肤功能。值得注意的是，研究表明皮肤微柱的直径决定了供皮区的发病率；然而，在大多数情况下，全厚皮肤微柱获取导致的供皮区创伤极小，远低于传统全厚皮片移植或断层皮片移植获取的创伤或发病率。在此，我们报告2例全厚皮肤微柱获取并植入双层真皮再生基质（Integra）以实现持久的一期皮肤替代且几乎没有供皮区发病率的病例。
