University of Cambridge, School of Clinical Medicine, Cambridge, UK.
Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK.
J Plast Reconstr Aesthet Surg. 2024 Jan;88:501-516. doi: 10.1016/j.bjps.2023.11.046. Epub 2023 Nov 30.
Artificial dermal substitutes (ADMs) have been trialled to improve outcomes at the donor site following the harvesting of a radial forearm free flap (RFFF). This systematic review compares donor site aesthetic and functional outcomes, with the use of an ADM versus conventional practice.
The databases Medline, Embase, Cochrane Library, Web of Science (Core Collection), and Scopus were searched for retrospective, prospective, and case-control studies and randomised control trials (RCTs) involving any ADM. Studies with adult patients having undergone RFFF harvesting and donor site repair with an ADM, commenting on appropriate clinical outcomes and without high risk of bias, were included. Direction-of-effect analysis was performed on relevant groupings of studies since heterogeneity in outcome measurement precluded meta-analyses.
Across eight non-comparative studies included, 132 patients had donor site coverage with AlloDerm™, Integra™, Matriderm™, or Rapiderm. Across 11 comparative studies included, 240 patients had donor site coverage with fish-skin matrix, AlloDerm™, amniotic membrane, MegaDerm™, Hyalomatrix, Integra™, or Matriderm™. Five out of 11 comparative studies demonstrated superior aesthetic outcomes with ADMs according to at least one aesthetic metric compared to controls, whilst 6/11 demonstrated superior functional outcomes with ADMs. No study demonstrated poorer aesthetic or functional outcomes with an ADM compared to conventional practice.
In summary, the lack of studies reporting poorer outcomes with them compared to conventional practices, and a cumulative effect direction in their favour, provide strong indications in support of the use of AlloDerm™, Integra™, or Matriderm™ grafts. Further comparative studies, including RCTs, are needed to reinforce these initial indications.
人工真皮替代物（ADM）已被尝试用于改善桡侧前臂游离皮瓣（RFFF）采集后的供区结局。本系统评价比较了 ADM 与常规治疗在供区美学和功能结局方面的差异。
检索 Medline、Embase、Cochrane 图书馆、Web of Science（核心合集）和 Scopus 数据库，纳入涉及任何 ADM 的回顾性、前瞻性和病例对照研究以及随机对照试验（RCT）。纳入的研究为成人患者接受 RFFF 采集和 ADM 修复供区的研究，报道了适当的临床结局，且偏倚风险低。由于结局测量存在异质性，无法进行荟萃分析，因此对相关研究进行了方向性效应分析。
纳入的 8 项非对照研究中，共有 132 例患者使用 AlloDermTM、 IntegraTM、MatridermTM 或 Rapiderm 覆盖供区。纳入的 11 项对照研究中，共有 240 例患者使用鱼皮基质、AlloDermTM、羊膜、MegaDermTM、Hyalomatrix、 IntegraTM 或 MatridermTM 覆盖供区。根据至少一种美学指标，11 项对照研究中的 5 项研究显示 ADM 的美学结局优于对照组，而 6/11 项研究显示 ADM 的功能结局优于对照组。没有研究显示 ADM 较常规治疗的美学或功能结局更差。
总体而言，与常规治疗相比，ADM 缺乏结局更差的报道，且支持 ADM 的累积效应明显，这强烈提示可使用 AlloDermTM、 IntegraTM 或 MatridermTM 移植物。需要进一步开展包括 RCT 在内的对照研究，以加强这些初步证据。
