Comparative Study of Artificial Dermis and Free Skin Grafting in Repairing Skin and Soft Tissue Defects of Finger Pulp
Department of Hand and Foot Surgery，Affiliated Nanjing Tongren Hospital，The Medical College of Southeast University
Department of Orthopaedics，the Air Force Hospital of the Eastern Theater Command，The Fifth Clinical College of Anhui Medical University
摘要目的 比较人工真皮与游离植皮修复指腹皮肤软组织缺损的临床效果。方法 回顾性分析自2018年6月至2020年6月间收治的指腹皮肤软组织缺损病例115例。根据手术方式不同分为游离植皮组63例，人工真皮组52例。游离植皮组男56例，女7例，平均年龄(45.56±7.57)岁；人工植皮组男47例，女5例，平均年龄(48.85±6.26)岁。游离植皮组在清创后一期采用自体取中厚皮片植皮；人工真皮组在清创后一期采用人工真皮覆盖；两组术后均加压包扎，术后1周拆除加压包，隔日换药。比较两组移植物存活率、手术次数、手术时间、住院时间、住院费用和创面完全愈合时间；采用国际标准评价两组指腹感觉等级和两点辨别觉；采用总主动活动度(total active range of motion，TAM)系统评定两组手功能恢复情况。结果 两组移植物存活率、手术次数和住院时间比较，差异均无统计学意义(P＞0.05)；游离植皮组手术时间长于人工真皮组，差异有统计学意义(P＜0.05)；游离植皮组住院费用和创面完全愈合时间均少于人工真皮组，差异有统计学意义(P＜0.05)；两组指腹感觉等级达到S3+比例、指腹两点辨别觉和TAM评分比较，差异均无统计学意义(P＞0.05)。结论 人工真皮修复指腹皮肤软组织缺损的手术操作更加简单、创伤更小、临床效果良好，但增加了治疗时间和住院费用。
Abstract：Objective To compare the clinical effects of artificial dermis and free skin grafting in repairing skin and soft tissue defects of finger pulp.Methods A retrospective analysis was conducted on 115 patients with skin and soft tissue defects of finger pulp surgically managed between June 2018 and June 2020.Of the 115 patients，63 patients were treated with free skin grafting (the free skin grafting group)，while the remaining 52 patients treated with artificial dermis (the artificial dermis group).In the free skin graft group，there were 56 males and 7 females，with an average age of (45.56±7.57)years old.There were 47 males and 5 females in the artificial skin grafting group，with an average age of (48.85±6.26)years old.In the free skin grafting group，autologous medium thickness skin graft was used in the first stage after debridement，while the artificial dermis group was covered with artificial dermis.Both groups were set pressure bandaged after operation.The pressure package was removed 1 week after operation and the dressing was changed every other day.The graft survival rate，operation times，operation time，hospital stay and complete wound healing time were compared between the two groups.The sensory grade of finger abdomen and two-point discrimination were evaluated by international standards.The total active range of motion(TAM) system was used to evaluate the recovery of hand function in the two groups.Results There was no significant difference between the two groups in the graft survival rate，the number of operations and the hospital stay (P＞0.05).The operation time of free skin grafting group was longer than that of artificial dermis group (P＜0.05).The hospitalization cost and the wound complete healing time in the free skin grafting group were less than those in the artificial dermis group (P＜0.05).There was no significant difference between the two groups in the S3+ sensation rate，the two-point discrimination and the TAM score (P＞0.05).Conclusion The operation of repairing the skin and soft tissue defect of finger pulp with artificial dermis is simpler，less trauma and good clinical effect，but it increases the treatment time and hospitalization cost.
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