Clinical Application Of Acellular Allogenic Dermis In Acrocutaneous Malignancies

Objective:To investigate the clinical effect of acellular allograft and autologous thin skin grafts in the treatment of acrocutaneous malignanciesMethods:This study is a prospective randomized controlled study,which has been reviewed by the ethics committee of our institution.Patients with skin malignant tumors who were treated in the Department of Orthopedics of our hospital from June2021 to October 2022 were collected.The general clinic data,such as: age,gender,tumor location(upper or lower limbs),tumor pathological type(malignant melanoma,squamous cell carcinoma,basal cell carcinoma),tumor size(cm~2),tumor diameter(cm)were recorded before the operation.According to the random number method,the patients were divided into experimental group and control group,and the two groups were treated differently.After inclusion criteria and exclusion criteria,and excluding patients who withdrew from the experiment for various reasons,37 patients in the experimental group and 33 patients in the control group were finally included in the study.According to the location of the tumor and the depth of tumor invasion,the skin tumor was resected.In the experimental group,the skin defect was repaired with acellular allogeneic dermis combined with split-thickness skin graft.In the control group split-thickness skin grafting was performed to repair skin defects.The wounds of the two groups were properly bandaged,the affected side was immobilized,routine postoperative care was performed,and the accessories were removed two weeks after operation.The postoperative follow-up plan(0-6 months)and a number of evaluation indicators were formulated to evaluate the efficacy of composite transplantation of acellular allogeneic dermis combined with autologous split-thickness skin graft.For numerical variables,D test was used to determine whether the data were normally distributed.Chi-square test,or t test,or u test was used to compare the data between the two groups according to the data type.P < 0.05 was considered statistically significant.Results:There was no significant difference in general clinical data between the experimental group and the control group,so they were comparable.There was no tumor recurrence in the two groups during the follow-up period of 6 months after surgery,indicating that the surgical resection was complete.Compared with the control group,the experimental group:(1)There was no significant difference in operation time.(2)Healing of the recipient site: on the 14 th nd day after operation,the survival rate of the skin graft was higher(85% vs 77%),and the healing time of the skin graft was shorter(12 days vs 14 days),and the difference was statistically significant.The incidence of subcutaneous effusion or infection in the experimental group was slightly lower than that in the control group(3 cases vs 7 cases),but the difference was not significant.For patients with almost total skin graft necrosis who needed skin grafting operations again,the experimental group was slightly lower than the control group(2 cases vs 4 cases),but the difference was not significant.(3)The visual analogue scale(VAS)for pain of the experimental group was slightly lower than that of the control group at 7 d(4.0 vs 5.0)and 14 d(3.0 vs 3.0)after the operation,but the difference was not statistically significant.(4)There was no significant difference in the healing of donor sites between the two groups.(5)On the30 th day after operation,the skin thickness and the number of blood vessels were measured by ultrasound.The skin thickness in experimental group was thicker than that in the control group(3.5mm vs 2.1mm),and the number of blood vessels was more(5.0 vs 4.0).These differences were statistically significant.(6)During 30 d after operation,the experimental group was better than the control group in the sense of touch,pain and temperature evaluated by Bartling method.However,it was only slightly better than the control group at 180 days,and the difference was not significant.(7)The total score,color and softness of VSS(Vancouver scar scale)in the experimental group were better than those in the control group,but there was no significant difference in blood vessel and thickness.Conclusions:Acellular allogeneic dermis combined with autologous split-thickness skin graft has achieved good results in the treatment of repairing large area defects after skin malignant tumor surgery.The advantages are: ease of operation,less damage to the donor site,increase of skin graft survival rate,acceleration of skin graft healing,increase of skin thickness,up-regulation of the formation of subcutaneous vascular network,benefit of the recovery of sensation in the operation area,and reduction of postoperative scar.Therefore,this is an effective surgical method,which is worthy of promotion and application.