Is the Dermis Graft a Reliable and Effective Option for Wound Coverage?
Notice bibliographique
Résumé
Sir Seung-Kyu Han and coworkers reported on the dermis graft for wound coverage.1 They advocate (for small to medium-sized wounds on exposed areas, such as the face, neck, forearms, and hands) the dermis graft technique (applied to 53 wounds) as superior compared with the regular skin graft technique (applied to 33 wounds). Data were verified by the Vancouver Scar Scale and a visual analogue scale (for patient satisfaction). Better aesthetic outcomes for both the recipient and donor sites, a faster donor-site healing process, and reduced patient pain and discomfort were claimed to be the main advantages. By the way, we believe that many of the advantages mentioned in the article are due to the basic principles of plastic surgery. It is well known that the amount of dermis included with the graft determines both the likelihood of survival and the amount of contracture. Also, the recovery and aesthetic outcome of the full-thickness graft are superior to those of the split-thickness graft.2 We usually harvest 0.015-inch split-thickness skin grafts applied principally on wounds with a well-vascularized bed, over periosteum, peritenon, or perineurium. However, use of both split- and full-thickness skin grafts follows strict indications (i.e., they are used for traumatic wounds that cannot be closed primarily, defects after oncologic resection, burns, scar releasing, congenital pathologies (i.e., syndactyly), and nipple-areola reconstruction). If the harvesting technique is correct, a proper dressing is applied, and good postoperative care is taken, morbidity is minimized.3 The dermis graft seems to have only a slight advantage in donor-site morbidity, particularly with regard to pain, because of the immediate covering of the exposed nerve fibers. On the other hand, as reported, for re-epithelialization of large defects, the healing process can be very long. We never use skin grafts on the face and neck, except in oncologic cases, in the elderly, and when general conditions are compromised, thereby requiring a short operation time, where small to medium defects should be closed by means of local flaps. The main advantages of local flaps are that they have the same texture and pliability as the surrounding skin (improved cosmetic appearance), they have a reliable blood supply, there is minimal donor-site morbidity, they have the ability to restore sensation despite being technically more challenging, size is limited (two or more contemporary flaps may be necessary in large defects, if not skin expansion), and the arc of rotation can be limited. In the end, skin substitutes (such as Hyalomatrix, Integra, AlloDerm, Apligraf, and so on) are today very common in clinical practice, principally for medium to large defects.4–7 Skin substitutes or a combination of dermal substitutes and cultured epithelium may replace autografting. These procedures are still expensive and, in our experience, heal with a conspicuous and unfavorable scar, but they do not require a donor site, and it is probable that in the near future, as the technology improves, skin substitutes will replace, in great measure, skin grafting. Luigi Annacontini, M.D. Domenico Parisi, M.D. Aurelio Portincasa, M.D. Plastic and Reconstructive Surgery Department, University of Foggia, Foggia, Italy
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,002 |
| Communication savante | 0,001 | 0,003 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».