Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2023; 11(33): 8003-8012
Published online Nov 26, 2023. doi: 10.12998/wjcc.v11.i33.8003
Artificial dermis combined with skin grafting for the treatment of hand skin and soft tissue defects and exposure of bone and tendon
Wei Wang, Dong-Sheng Chen, Zhao-Di Guo, Dan Yu, Qin Cao, Xiao-Wei Zhu
Wei Wang, Dong-Sheng Chen, Dan Yu, Xiao-Wei Zhu, Department of Operating Room, The First People Hospital of Jiangxia District, Wuhan 430200, Hubei Province, China
Zhao-Di Guo, Qin Cao, Department of Hand Surgery, The First People Hospital of Jiangxia District, Wuhan 430200, Hubei Province, China
Co-first authors: Wei Wang and Dong-Sheng Chen.
Author contributions: Wang W and Chen DS designed the research; Wang W, Chen DS, Guo ZD, Cao Q, and Yu D performed the research; Zhu XW contributed new reagents/analytic tools; Zhu XW, Guo ZD, Cao Q, and Yu D analyzed the data; Wang W and Chen DS wrote the paper; All authors were involved in the critical review of the results and have contributed to, read, and approved the final manuscript. Wang W and Chen DS contributed equally to this work as co-first authors. The reasons for designating Wang W and Chen DS as co-first authors are threefold. First, the research was performed as a collaborative effort, and the designation of co-corresponding authorship accurately reflects the distribution of responsibilities and burdens associated with the time and effort required to complete the study and the resultant paper. This also ensures effective communication and management of post-submission matters, ultimately enhancing the paper's quality and reliability; Second, the overall research team encompassed authors with a variety of expertise and skills from different fields, and the designation of co-first authors best reflects this diversity. This also promotes the most comprehensive and in-depth examination of the research topic, ultimately enriching readers' understanding by offering various expert perspectives; Third, Wang W and Chen DS contributed efforts of equal substance throughout the research process. The choice of these researchers as co-first authors acknowledges and respects this equal contribution, while recognizing the spirit of teamwork and collaboration of this study. In summary, we believe that designating Wang W and Chen DS as co-first authors is fitting for our manuscript as it accurately reflects our team's collaborative spirit, equal contributions, and diversity.
Supported by Clinical Study of Artificial Dermis Combined with Skin Flap Replacement Flap in Limb Wound Repair, No. WX21C27.
Institutional review board statement: This study protocol was approved by The First People’s Hospital of Jiangxia District, and all the families have voluntarily participated in the study and have signed informed consent forms.
Informed consent statement: All study participants or their legal guardian provided informed written consent prior to study enrolment.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this study.
Data sharing statement: Data generated from this investigation are available upon reasonable quest from the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Wei Zhu, MD, Chief Physician, Department of Operating Room, The First People Hospital of Jiangxia District, No. 1 Cultural Avenue, Jiangxia District, Wuhan 430200, Hubei Province, China. xiaoweizhu0818@163.com
Received: September 25, 2023
Peer-review started: September 25, 2023
First decision: October 17, 2023
Revised: October 25, 2023
Accepted: October 30, 2023
Article in press: October 30, 2023
Published online: November 26, 2023
Abstract
BACKGROUND

The recovery time of hand wounds is long, which can easily result in chronic and refractory wounds, making the wounds unable to be properly repaired. The treatment cycle is long, the cost is high, and it is prone to recurrence and disability. Double layer artificial dermis combined with autologous skin transplantation has been used to repair hypertrophic scars, deep burn wounds, exposed bone and tendon wounds, and post tumor wounds.

AIM

To investigate the therapeutic efficacy of autologous skin graft transplantation in conjunction with double-layer artificial dermis in treating finger skin wounds that are chronically refractory and soft tissue defects that expose bone and tendon.

METHODS

Sixty-eight chronic refractory patients with finger skin and soft tissue defects accompanied by bone and tendon exposure who were admitted from July 2021 to June 2022 were included in this study. The observation group was treated with double layer artificial dermis combined with autologous skin graft transplantation (n = 49), while the control group was treated with pedicle skin flap transplantation (n = 17). The treatment status of the two groups of patients was compared, including the time between surgeries and hospital stay. The survival rate of skin grafts/flaps and postoperative wound infections were evaluated using the Vancouver Scar Scale (VSS) for scar scoring at 6 mo after surgery, as well as the sensory injury grading method and two-point resolution test to assess the recovery of skin sensation at 6 mo. The satisfaction of the two groups of patients was also compared.

RESULTS

Wound healing time in the observation group was significantly longer than that in the control group (P < 0.05, 27.92 ± 3.25 d vs 19.68 ± 6.91 d); there was no significant difference in the survival rate of skin grafts/flaps between the two patient groups (P > 0.05, 95.1 ± 5.0 vs 96.3 ± 5.6). The interval between two surgeries (20.0 ± 4.3 d) and hospital stay (21.0 ± 10.1 d) in the observation group were both significantly shorter than those in the control group (27.5 ± 9.3 d) and (28.4 ± 17.7 d), respectively (P < 0.05). In comparison to postoperative infection (23.5%) and subcutaneous hematoma (11.8%) in the control group, these were considerably lower at (10.2%) and (6.1%) in the observation group. When comparing the two patient groups at six months post-surgery, the excellent and good rate of sensory recovery (91.8%) was significantly higher in the observation group than in the control group (76.5%) (P < 0.05). There was also no statistically significant difference in two point resolution (P > 0.05). The VSS score in the observation group (2.91 ± 1.36) was significantly lower than that in the control group (5.96 ± 1.51), and group satisfaction was significantly higher (P < 0.05, 90.1 ± 6.3 vs 76.3 ± 5.2).

CONCLUSION

The combination of artificial dermis and autologous skin grafting for the treatment of hand tendon exposure wounds has a satisfactory therapeutic effect. It is a safe, effective, and easy to operate treatment method, which is worthy of clinical promotion.

Keywords: Bilayer artificial dermis, Autologous skin graft, Tendon exposure, Bone exposure

Core Tip: In this study, the observation group and the control group were treated with Lando double-layer artificial dermis and pedicled skin flap transplantation to repair hand wounds, respectively. There was no significant difference in the survival rate between the two groups of skin grafts/flaps after surgery. However, compared to the control group, the observation group had shorter surgical intervals and hospital stays, and the appearance of the fingers after surgery was better. The observation group also had better skin contracture and scar formation than the control group, resulting in higher satisfaction in the observation group.