牛大伟　韩志新　李振超　樊昌伟

[关键词]脱细胞真皮基质;自体皮移植;封闭负压引流;肌腱外露;创面

[中图分类号]R622+.1    [文献标志码]A    [文章编号]1008-6455（2021）12-0001-04

Repairing Tendon Exposed Wounds by Stage ⅡAutologous Skin Transplantation Combined with Vacuum Sealing Drainage after Transplantation of Allogenic Acellular Dermal Matrixon

NIU Da-wei，HAN Zhi-xin，LI Zhen-chao，FAN Chang-wei

（Department of Burn and Plastic Surgery，Anyang People’s Hospital，Anyang 455000，Henan，China）

Abstract： Objective  To investigate the effect of allogeneic acellular dermal matrix combined with autologous skin transplantation and negative pressure drainage and in the treatment of tendon exposed wound. Methods   Betwwen January 2017 and  January 2020，a total of fourteen patients with tendon exposed were analyzed retrospectively. All patients underwent acellular dermal matrix transplantation firstly，and in the second stage， autologous skin grafting combined with vacuum sealing drainage were actualized to repair wounds.Then the survival rate of ADM，the time interval between two operations， the survival rate of the autologous skin grafting，the wound healing period， the total hospital cost ， and the rupture of the skin graft after 3 months follow-up were observed. Results  In the 14cases， the average survival rate of ADM was 100%，the average interval of two operations was （8.5 ± 0.9） day， the average survival rates of autologous kin graft was （97.0±2.7）%， the average wound healing time after skin grafting was （12.3 ± 1.8） day， the average healing time of donor site was （8.4± 1.3） day， the average total hospital cost was （2.2 ± 0.3） ten thousand yuan， and got satisfactory appearance without recurrent skin ulcer in 3 months follow-up. Conclusion  Repairing tendon exposed wounds by stage Ⅱautologous skin transplantation combined with vacuum sealing drainage after transplantation of allogenic acellular dermal matrixon accord with the principle of wound bed preparation， shorten the treatment time， reduces the injury to the patient and it provides a feasible strategy for the repairing of the wound with small area tendon exposure.

Key words： acellular dermal matrix; autologous skin graft; vacuum sealing drainage; tendon exposed; wound

治療各种原因导致的肌腱外露创面仍是一个棘手问题[1-2]，特别是手足等部位皮肤覆盖较薄，受伤后易致软组织缺损，造成深部组织肌腱、骨和神经血管等外露，创面愈合困难[3]。传统的治疗方法有皮片移植或皮瓣移植，但皮片直接移植于肌腱上成活率较低、且增加了肌腱粘连风险[4]。而皮瓣移植存在手术操作要求高、术后护理要求严格、对供区损伤大、术后创面外观臃肿、部分患者不耐受等不足[5-6]。人工真皮是近年临床上治疗骨或肌腱外露的新型有效方法[7-8]，但人工真皮也存在血管化周期长，抗感染能力差等问题[9-10]。脱细胞真皮基质（Acellular dermal matrix，ADM）抗原性低，且具备正常胶原的三维结构，能够为新生组织提供类似细胞支架的作用，具有良好的细胞亲和力、组织相容性、抗感染能力和理化性质等[11]，用于覆盖创面可取得较好的疗效[12]，这其中又以异体脱细胞真皮基质的同源性最好。ADM良好的生物相容性和支撑效果，使其有可能成为肌腱修复的最佳材料[13]，且ADM植入组织后，在局部形成一层物理屏障，可以预防创伤局部的组织粘连和病理性增生[14]。目前关于异体ADM覆盖外露肌腱创面报道较少，本研究通过回顾性分析收治的该类患者创面采用异体ADM联合自体皮移植修复的效果，以期为临床提供更多的参考依据。

1  资料和方法

1.1 一般资料：本研究共纳入14例肌腱外露创面患者，年龄27～65岁，其中男性10例，女性4例。……