피판술 후 공여부결손에 적용한 가공된 무세포 동종진피(AlloDerm): 감성 측정

Abstract

Numerous choices exist for closing any wound, so the surgical challenge is that of selecting the optimal method. It is necessary to balance multiple factors, including recipient site requirements, donor site morbidity, operative complexity, and patient factors. Limiting the donor site morbidity is emphasized in the aphorism "Never rob Peter to pay Paul unless Peter can afford it. Certainly, documented cases exist in which donor site morbidity exceeds the original recipient problem, necessitating a second procedure to reconstruct the donor site. The flap survived and the wound was closed, but the donor site was often worse than the original defect. Numerous donor site complications are often overlooked while one concentrates on the successful flap transfer. The standard method for grafting donor wound after harvesting of a flap uses thick split-thickness skin grafts. This method, however, creates an additional comlication-prone wound at the donor sites. Donor sites for grafting can be painful and may develop infection, hypertrophic scarring, blistering. The problem of donor sites scar hypertrophy occurs most frequently when a graft is taken at more than 0.012 inch thick, leaving a residual dermal bed is too thin. AlloDerm processed allograft dermis was developed as a permanent dermal transplant for full thickness wounds. Between 1997 and 1999, we have applied AlloDerm grafts and ultra-thin autografts on 11 patients with donor sites after harvesting flaps. All the composite AlloDerm /autograft were noted to be firmly adherent except 2 cases, which showed focal loss of the grafts and was healed after second graft. AlloDerm exhibited a high percentage take and supported an overlying ultra thin split-thickness skin autograft, applied simultaneously. By providing a dermal replacement, the grafted dermal matrix permitted a thin autograft from the donor site. The ultra-thin autografts leave donor sites that heal faster and with fewer complication. AlloDerm dermal transplants exhibit excellent elastisity and good pigmentation with minimal scarring or wound contracture. Sensory reinnervation after the composite AlloDerm/autograft was not fully recovered. The reason was that these grafts were placed on the bone or tendon exposed sites which were not sufficiently well- innervated graft bed. The high reproducibility of excellent results with this composite graft, coupled with the reduced trauma and rapid healing of donor sites associated with ultra-thin autograft STSG, has made composite grafting with the use of AlloDerm dermal transplants our new method of choice for treatment of donor defects of flap surgery.

저자들은 피판술후 생긴 공여부에 AlloDerm을 이용하여 외형적 및 기능적으로 만족한 결과를 얻을 수 있었다. 연조직의 결손상의 정도가 심하여 피판술이 불가피할 경우 여러 가지 점들을 고려해서 적합한 피판을 선택하는 일이 중요하며, 그 중 공여부에 생기게 될 병적 상태는 아무리 우수하고 다양한 쓰임새의 피판이라 하더라도 그 피판의 이용을 망설이게 하는데, AlloDerm의 이용은 감각 기능의 회복 정도는 크게 만족스럽지 못하지만, 피판술의 공여부 결손상 문제를 해결할 수 있는 좋은 방법 중의 하나이며, 다양한 조건의 전층피부 및 연조직 결손부에 폭넓게 이용할 수 있을 것으로 생각된다.