To explore the clinical effect of co-transplantation of the acellular allogeneic dermis and autologous razor-thin skin for repairing wounds in the non-weight-bearing area of the foot and ankle.

A retrospective cohort study was performed. From January 2015 to March 2021, 51 patients with skin and soft tissue defects in the non-weight-bearing area of the foot and ankle were admitted to the Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Patients were grouped according to different treatment methods. 24 patients who received composite skin transplantation were designated as the co-transplantation group, and 27 patients who received autologous full-thickness skin grafting were designated as the full-thickness skin transplantation group. After debridement of the wound, the co-transplantation group was covered with the acellular allogeneic dermis, which was covered with autologous razor-thin skin grafts for combined transplantation, and the full-thickness skin graft group was covered with autologous full-thickness skin grafts. The survival rate of grafts, wound healing time, donor site healing time, and wound regrafting rate were evaluated postoperatively in both groups. The postoperative follow-up was 12 months, and AOFAS ankle function evaluation and vancouver scar scale (VSS) were performed at the last follow-up. Data were compared using the t-test, Wilcoxon test, chi-square test and Fisher′s exact test.

The postoperative evaluation showed that all the transplantations in the two groups survived. The regrafting rate due to partial necrosis of the skin graft in the full-thickness skin transplantation group (22.2%, 6/27) was higher than that in the co-transplantation group (4.2%, 1/24) but no statistically significant difference (P= 0.103). The wound healing time in the co-transplantation group was 17.0 (15.8, 18.0) d, which was significantly shorter than that in the full-thickness skin transplantation group, which was 24.0 (18.0, 38.0) d, and the difference was statistically significant (Z=-4.222, P< 0.01). There was no significant difference in the healing time of the donor site between the two groups (P> 0.05). The AOFAS ankle function score of the co-transplantation group was 93.0 (92.0, 95.0) points, which was significantly better than that of the full-thickness skin graft group, which was 87.0 (84.0, 91.5) points (Z= 3.574, P< 0.01). The VSS score of the co-transplantation group was 5.0 (4.0, 6.0) points, which was better than that of the full-thickness skin transplantation group, which was 7.0 (5.5, 8.5) points, and the difference was statistically significant (Z=-3.823, P< 0.01).

The co-transplantation of the acellular allogeneic dermis and autologous razor-thin skin graft can effectively repair the wound in the non-weight-bearing area of the foot and ankle, significantly reduce the postoperative scarring, preserve good ankle function after surgery, and promote wound healing.