双层人工真皮修复指端缺损并骨外露

Double-layer artificial dermis for repair of finger tip defect complicated with bone exposed

摘要:

[目的] 探讨Lando?双层人工真皮修复材料修复指端缺损伴指骨外露创面的临床疗效。[方法] 2020 年1 月—2022年12 月作者对30 例（30 指） 因各种外伤导致手部指端缺损合并指骨外露患者行清创后，采用双层人工真皮缝合于缺损处，打包加压包扎。术后7~10 d 拆除加压缝合包，术后3 周拆除缝线，术后4 周揭除双层人工真皮表面硅胶膜，让创面自然上皮化。观察创面愈合外观及功能恢复，评估疗效。[结果] 30 例患者中，27 例创面均一期愈合；2 例患者部分创面残留，但无骨外露，换药后愈合；1 例患者术后仍部分肌腱外露，再次行双层人工真皮移植修复后愈合。所有创面自然上皮化时间平均为（60.1±8.8） d。术后随访均超过6 个月，创面愈后指腹饱满，色泽良好，皮肤感觉良好。与术后3 个月相比，术后6 个月两点辨别觉显著改善[(3.8±1.1) mm, (2.5±0.9) mm, P＜0.001]。[结论] 双层人工真皮一期修复指端合并骨外露缺损创面操作简单，供区损伤小，疗效可靠。

Abstract:

[Objective] To investigate the clinical efficacy of Lando? double-layer artificial dermis used for repair of finger tip defectcomplicated with bone exposed. [Methods] From January 2020 to December 2022, 30 patients (30 fingers) had double-layer artificial der-mis with pressure dressing used after debridement to repair the finger tip defect complicated with bone exposed. The compression suture kitwas removed 7~10 days after surgery, the sutures were removed 3 weeks after surgery, while the surface silicone film over double layer arti-ficial dermis was removed 4 weeks after surgery to allow the wound to be naturally epithelialized. The appearance of wound healing andfunctional recovery were observed, and the curative effect was evaluated. [Results] Of the 30 patients, 27 patients got wound healing in onestage, 2 patients had a part of the wound remained without bone exposure, and got wound healed after dressing change, whereas one patientremained a part of the tendon exposure after surgery, and had the tendon healed after revision double-layer artificial dermis implantation.All the patients were followed up for more than 6 months, with the mean time of natural epithelialization of (60.1±8.8) days. After the woundhealed, the finger belly was well-stacked with good color and proper skin sensation. Compared with that 3 months after surgery, the averagetwo-point discrimination was significantly improved at 6 months after surgery [(3.8±1.1) mm, (2.5±0.9) mm, P＜0.001]. [Conclusion] Thisdouble-layer artificial dermis used to repair of finger tip defect with bone exposed in one stage is simple and effective technique without do-nor area damage.