Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 468 - файл

Current soft tissue reconstructive therapies include local advancement aps, microvascular free tissue transfer, split- and full-thickness skin grafting, negative pressure therapy, and dermal substitutes. It is important to note that these techniques vary in the tissue layers they replace. Local aps and free tissue transfers not only replace all three layers of the skin (epidermis, dermis, and hypodermis), but they can also include any combination of skin, fascia, muscle, and bone. Their signicant clinical success has been attributed in large part to the maintenance of a vascular supply to transplanted tissues, either by retaining local vascular connections (local aps) or through anastomosis of transplanted arteries/veins with local blood vessels (free tissue transfers). In contrast, skin grafts do not provide immediate vascular perfusion to the transplanted tissues. Rather, they rely on the gradual formation of local vascular connections at the graft-wound bed interface. Unlike aps, skin grafts only replace the layers of the skin and do not include additional tissues such as fas­cia, muscle, or bone. Skin grafts can be either split-thickness, including epidermis with a variable amount of dermis, or full-thickness, including all layers of the skin. As will be explored in greater depth later in this chapter, dermal substitutes include a wide variety of decellularized allografts, xenografts, and fully synthetic matrices that primarily serve to replace or augment the dermal layer of the skin. Although they are typically used in conjunction with skin grafting, some have been success­fully used alone, as the primary reconstruction modality, and can effect reconstruc­tion of full-thickness epithelial defects. In comparison, negative pressure therapy does not replace any layers of the skin. Rather, it is a technique that uses a vacuum device to exert light, evenly distributed pressure on the wound surface and a conduit for uid removal from the wound site. The negative pressure created by the vacuum helps draw the edges of the wound together and secure any skin grafts or aps that may be present. It also helps to maintain a moist and warm environment conducive to wound healing and to reduce wound edema and infection. The above-listed tech­niques are often used in combination and are selected based on the complexity of each case, which is determined by factors such as anatomical location, depth, and size of the soft tissue defect, vascular supply, the presence or absence of infection, and systemic comorbidities.