Orthopaedics & Hand Surgery Unit, Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
Università Cattolica del Sacro Cuore, Roma, Italia.
J Cosmet Dermatol. 2022 Feb;21(2):750-757. doi: 10.1111/jocd.14115. Epub 2021 Apr 7.
Treatment of fingers tissue loss is particularly challenging as it often necessitates advanced reconstructive techniques such as flaps or grafts, with esthetic and functional results that are not always as good as hoped for, with long healing times. Recently, along with tissue engineering development, numerous types of dermal substitute have been commercialized, with promising possibilities of treatment in finger tissue loss. In the author's unit, Matriderm is the most commonly used dermal substitute. As described by the manufacturer, this scaffold is designed to be covered with a split-thickness skin graft. In using a two-step procedure, the authors realized that in most cases of fingertips injuries, at three weeks follow-up, the wound appeared in an advanced state of healing, which permitted to avoid grafting.
Between October 2017 and October 2018, 27 fingers have been included in this study. Patients have been divided in two groups: those treated with Matriderm alone (15 fingers) and those who had a skin graft three weeks after the first surgery (12 fingers). At the 6-month follow-up, authors evaluated the esthetic results with the Vancouver Scar Scale (VSS), the functional results with Quick Disability of the Arm, Shoulder and Hand (qDASH) score, and sensibility by the mean of two-point discrimination test (2-PD).
All outcomes were overlapping in patients treated with or without skin graft: mean VSS was 2.3, mean qDASH was 13.3, and mean 2-PD was 7.7 mm.
The results obtained allow to consider Matriderm , used also without skin graft coverage, as a valid solution for treatment of fingertip tissue loss.
手指组织缺损的治疗特别具有挑战性，因为它通常需要先进的重建技术，如皮瓣或移植物，其美观和功能结果并不总是如预期的那样好，且愈合时间较长。最近，随着组织工程学的发展，已经商业化了许多类型的真皮替代物，为手指组织缺损的治疗提供了有前景的可能性。在作者所在的单位，Matriderm 是最常用的真皮替代物。如制造商所述，这种支架旨在覆盖一层刃厚皮片。通过两步法，作者发现，在大多数指尖损伤的情况下，在 3 周的随访中，伤口呈现出高级愈合状态，从而可以避免植皮。
在 2017 年 10 月至 2018 年 10 月期间，这项研究纳入了 27 个手指。患者被分为两组：单独使用 Matriderm 治疗的（15 个手指）和在第一次手术后 3 周进行皮片移植的（12 个手指）。在 6 个月的随访中，作者用温哥华瘢痕量表（VSS）评估了美观结果，用快速上肢、肩部和手部残疾问卷（qDASH）评分评估了功能结果，用两点辨别测试（2-PD）评估了感觉。
在接受或不接受皮片移植治疗的患者中，所有结果均重叠：平均 VSS 为 2.3，平均 qDASH 为 13.3，平均 2-PD 为 7.7mm。
所获得的结果表明，Matriderm 也可以在不覆盖皮片的情况下用于治疗指尖组织缺损，是一种有效的治疗方法。
