[A prospective randomized controlled study of the effectiveness of artificial dermis combined with split-thickness skin for repair of wounds with bone and tendon exposure in the hand and foot].

Objective: To explore the clinical effects of artificial dermis combined with split-thickness skin for repair of wounds with bone and tendon exposure in the hand and foot. Methods: A prospective randomized controlled study was conducted. From October 2018 to February 2020, 82 patients with bone and tendon exposed wounds in the hand and foot admitted to Zhengzhou First People's Hospital who met the inclusion criteria were selected. All the patients were divided into flap group (41 cases, including 27 males and 14 females) and artificial dermis+split-thickness skin group (41 cases, including 29 males and 12 females) according to the random number table, both aged (37±7) years. After complete debridement of wounds of patients in the two groups, the wound of patients in flap group was transplanted with anterolateral femoral free flap; the wound of patients in artificial dermis+split-thickness skin group was grafted with artificial dermis and given continuous negative pressure suction, and autologous lateral thigh split-thickness skin was grafted until complete vascularization of artificial dermis. One week after autologous skin graft/flap grafting, the survival of wound graft was observed and the graft survival rate was calculated. The complete wound healing time, number of operation, length of hospital stay, hospitalization cost, the occurrence of surgery-related complications during hospitalization after autologous skin graft/flap grafting were recorded, and the incidence of complication was calculated. Six months after autologous skin graft/flap grafting, the scar hyperplasia of grafting area was evaluated by Vancouver Scar Scale (VSS), while the recovery of hand and foot function were evaluated by Total Action Mobility (TAM) System Rating method and American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Function Scale (AOFAS-AHS), respectively. Data were statistically analyzed with chi-square test, Fisher's exact probability test, and independent sample t test. Results: One week after autologous skin graft/flap grafting, the survival rates of wound grafts were similar in the two groups (P>0.05). The complete wound healing time and length of hospital stay were (29±5) and (35±5) d for patients in artificial dermis+split-thickness skin group, respectively, which were significantly longer than (22±4) and (28±5) d in flap group (t=6.96, 6.22, P 0.05). Six months after autologous skin graft/flap grafting, the VSS scores of grafting area of patients in the two groups were similar (t=0.32, P>0.05); the TAM score and AOFAS-AHS score of hand and foot function of patients in artificial dermis+split-thickness skin group were 40±6 and 62±12, respectively, which were significantly higher than 34±6 and 53±11 of flap group (t=4.66, 3.41, P<0.01). Conclusions: Repairing wounds with bone and tendon exposure in hand and foot with artificial dermis and split-thickness skin reduces the incidence of surgery-related complications, improves postoperative hand and foot joint function of patients, and results in fewer number of operation compared with flap repair, without significant scar hyperplasia, but may prolong wound healing time and length of hospital stay.