To investigate the clinical efficacy of one-stage transplantation of artificial dermis combined with split-thickness skin grafts for repairing skin defects in the skin flap donor site.

A retrospective review of 221 patients who underwent skin flap surgery at the Department of Orthopedics, Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to December 2021 was conducted. According to the repair method of the skin flap donor site, the patients were divided into two groups. There were 115 patients in the observation group, and the skin defect range of the skin flap donor site was 11-240cm². The patients were treated with one-stage transplantation of artificial dermis combined with split-thickness skin grafts. There were 106 patients in the control group, and the skin defect range of the skin flap donor site was 11-243cm².The patients were treated with one-stage transplantation of full-thickness skin grafts. Follow up for 6 to 24 months was conducted to observe the survival rate of two groups of skin grafts, healing time of the donor site, patient satisfaction [Visual Analog Self Rating Scale (VAS)], scar hyperplasia in the flap donor site [Vancouver scar scale (VSS)], and joint function of the upper and lower limbs around the donor site [disabilities of the arm shoulder and hand (DASH) and American orthopaedic foot and ankle society(AOFAS) ]. SPSS and GraphPad Prism 9 software were used for statistical analysis, and t-test, Wilcoxon test, chi square test, and Fisher′s exact test were used for data comparison.

The survival rate of the artificial dermis combined with blade thickness skin grafting group was slightly higher than that of the medium thickness skin grafting group, but the difference was not statistically significant (95.7% and 93.4%, P>0.05). There was no statistically significant difference between the two groups in wound healing time [observation group and control group were 18.00 (16.00, 20.00) days and 17.50 (16.00, 20.00) days respectively] and patient satisfaction [observation group and control group were 5.00 (4.00, 6.00) and 5.00 (4.00, 7.00) days respectively (P>0.05)]. The degree of scar formation in both the recipient and donor areas of the artificial dermis combined with blade thickness skin grafting group was better than that in the medium thickness skin grafting group (the VSS scores in the recipient area were 4.00 (3.00, 5.00) and 5.00 (4.00, 6.00), Z=-3.647, P<0.01). The VSS scores of the donor site were 2.00 (1.00, 3.00) and 4.00 (3.00, 4.25), Z=-8.859, P<0.01), respectively. The adjacent joint function of the artificial dermis combined with blade thick skin grafting group was significantly better than that of the medium thick skin grafting group [upper limb function scores were 41.50 (40.00, 47.00) and 49.00 (45.25, 54.00), Z=-4.961, P<0.01]. The lower limb function scores were 91.00 (87.00, 93.50) and 82.00 (78.00, 86.25) (Z=-7.857, P<0.01), respectively.

One-stage transplantation of artificial dermis combined with split-thickness skin grafts is a good method for repairing skin flap donor sites, which can provide good tissue coverage for the donor site, especially on the tendon sheath, while avoiding scar contracture and ensuring the effective sliding of tendon tissues, which is beneficial to the recovery of adjacent joint function.