Repair of foot and ankle skin defects in children with artificial dermis and full-thickness skin graft

Objective To evaluate the clinical outcomes of artificial dermis(Pelnac) combined with full-thickness skin graft in treating skin and soft tissue defects of foot and ankle in children.Methods From January 2011 to Feburary 2013,13 children (9 boys,4 girls) underwent transplantation of artificial dermis with full-thinkness abdomen or groin skin were retrospectively reviewed.The average age was 5.2 years old,ranged from 3 to 9 years.All of the soft tissue defects were caused by trauma.The area of skin and soft tissue defects ranged from 12 cm2 to 62 cm2.The area of bone or cartilage exposure ranged from 0.7 cm2 to 6.0 cm2.Initial debridement and vacuum sealing drainage(VSD) coverage were followed by Pelnac covering if the wounds did not infected after several days Full-thickness abdomen or groin skin was transplanted and the exposed bone or cartilage was covered by dermis-like tissues when the local granulation tissue grew well 2-3 weeks later.Results All cases had good coverage of the wounds and grafts survival.One case had skin defects about 0.5 cm × 0.5 cm on the surface of cartilage,and the defect was covered only by dressing.All the cases were followed up from 4 months to 14 months.The appearance of the recipient site is good without obvious scar in all cases.The donor skin heals well with linear scar.Conclusions Artificial dermis combined with full thickness skin graft is effective to repair skin and soft tissue defects associated with bone or cartilage exposure of foot and ankle.It can also avoid the poor appearance of the conventional flap and the large injury to the donor site. Key words: Soft tissue injury;  Skin grafting;  Full thinkness skin