不同敷料组合对烧伤患者供皮区创面微环境的影响

Objective To investigate the effect of dressing materials in various combinations on bum wound microenvironment and healing condition. Methods Two hundred donor sites with wounds of 0.3 mm in depth in 186 burn patients, who needed skingrafting and admitted to our ward were enrolled in study, and they were divided into A ( with dressing composed of aiginate + cotton pad for donor area), B ( with dressing composed of vaseline gauze + cotton pad for donor area) , C (with dressing composed of algi-nate+ foam dressing for donor area), D ( with dressing composed of vaseline gauze + foam dressing for donor area) groups according to random table method. Effect of dressings on wound evaporation and pH value were observed. Bacterial colonization, degree of pain complained by patients after dressing change, and wound healing time in each group were compared. Results One hundred and eighty-four patients complied with the study, while 2 patients were excluded due to untimely falling-off of the dressing. Wound evaporaton in respectively, among them B group showed optimal effect of keeping humidity (P<0.01). Wound pH value in A, B, C, D groups was 7.22±0.06, 7.41±0.03, 7.05±0.03, 7.34±0.06, respectively, among them it was highest in B group. The positive rate of bacteria in D group was highest (22.4%), and lowest in C group (4.0%). Pain was lightest in C group (score was 0.98±0.12), and most serious in B group ( score was 8.14±0.82). The shortest wound healing time was seen in C group (6.7±0.8 d) , and longest in D group (15.6±3.5 d). Conclusions Application of various dressings on similar wounds can pro-duce different wound microenvironment, which is closely related to wound healing time. Compared with pH value, humidity is the more important factor for wound healing.     

不同敷料组合对烧伤患者供皮区创面微环境的影响

Objective To investigate the effect of dressing materials in various combinations on bum wound microenvironment and healing condition. Methods Two hundred donor sites with wounds of 0.3 mm in depth in 186 burn patients, who needed skingrafting and admitted to our ward were enrolled in study, and they were divided into A ( with dressing composed of aiginate + cotton pad for donor area), B ( with dressing composed of vaseline gauze + cotton pad for donor area) , C (with dressing composed of algi-nate+ foam dressing for donor area), D ( with dressing composed of vaseline gauze + foam dressing for donor area) groups according to random table method. Effect of dressings on wound evaporation and pH value were observed. Bacterial colonization, degree of pain complained by patients after dressing change, and wound healing time in each group were compared. Results One hundred and eighty-four patients complied with the study, while 2 patients were excluded due to untimely falling-off of the dressing. Wound evaporaton in respectively, among them B group showed optimal effect of keeping humidity (P<0.01). Wound pH value in A, B, C, D groups was 7.22±0.06, 7.41±0.03, 7.05±0.03, 7.34±0.06, respectively, among them it was highest in B group. The positive rate of bacteria in D group was highest (22.4%), and lowest in C group (4.0%). Pain was lightest in C group (score was 0.98±0.12), and most serious in B group ( score was 8.14±0.82). The shortest wound healing time was seen in C group (6.7±0.8 d) , and longest in D group (15.6±3.5 d). Conclusions Application of various dressings on similar wounds can pro-duce different wound microenvironment, which is closely related to wound healing time. Compared with pH value, humidity is the more important factor for wound healing.     

不同敷料组合对烧伤患者供皮区创面微环境的影响

Objective To investigate the effect of dressing materials in various combinations on bum wound microenvironment and healing condition. Methods Two hundred donor sites with wounds of 0.3 mm in depth in 186 burn patients, who needed skingrafting and admitted to our ward were enrolled in study, and they were divided into A ( with dressing composed of aiginate + cotton pad for donor area), B ( with dressing composed of vaseline gauze + cotton pad for donor area) , C (with dressing composed of algi-nate+ foam dressing for donor area), D ( with dressing composed of vaseline gauze + foam dressing for donor area) groups according to random table method. Effect of dressings on wound evaporation and pH value were observed. Bacterial colonization, degree of pain complained by patients after dressing change, and wound healing time in each group were compared. Results One hundred and eighty-four patients complied with the study, while 2 patients were excluded due to untimely falling-off of the dressing. Wound evaporaton in respectively, among them B group showed optimal effect of keeping humidity (P<0.01). Wound pH value in A, B, C, D groups was 7.22±0.06, 7.41±0.03, 7.05±0.03, 7.34±0.06, respectively, among them it was highest in B group. The positive rate of bacteria in D group was highest (22.4%), and lowest in C group (4.0%). Pain was lightest in C group (score was 0.98±0.12), and most serious in B group ( score was 8.14±0.82). The shortest wound healing time was seen in C group (6.7±0.8 d) , and longest in D group (15.6±3.5 d). Conclusions Application of various dressings on similar wounds can pro-duce different wound microenvironment, which is closely related to wound healing time. Compared with pH value, humidity is the more important factor for wound healing.     

不同敷料组合对烧伤患者供皮区创面微环境的影响

Objective To investigate the effect of dressing materials in various combinations on bum wound microenvironment and healing condition. Methods Two hundred donor sites with wounds of 0.3 mm in depth in 186 burn patients, who needed skingrafting and admitted to our ward were enrolled in study, and they were divided into A ( with dressing composed of aiginate + cotton pad for donor area), B ( with dressing composed of vaseline gauze + cotton pad for donor area) , C (with dressing composed of algi-nate+ foam dressing for donor area), D ( with dressing composed of vaseline gauze + foam dressing for donor area) groups according to random table method. Effect of dressings on wound evaporation and pH value were observed. Bacterial colonization, degree of pain complained by patients after dressing change, and wound healing time in each group were compared. Results One hundred and eighty-four patients complied with the study, while 2 patients were excluded due to untimely falling-off of the dressing. Wound evaporaton in respectively, among them B group showed optimal effect of keeping humidity (P<0.01). Wound pH value in A, B, C, D groups was 7.22±0.06, 7.41±0.03, 7.05±0.03, 7.34±0.06, respectively, among them it was highest in B group. The positive rate of bacteria in D group was highest (22.4%), and lowest in C group (4.0%). Pain was lightest in C group (score was 0.98±0.12), and most serious in B group ( score was 8.14±0.82). The shortest wound healing time was seen in C group (6.7±0.8 d) , and longest in D group (15.6±3.5 d). Conclusions Application of various dressings on similar wounds can pro-duce different wound microenvironment, which is closely related to wound healing time. Compared with pH value, humidity is the more important factor for wound healing.     

不同敷料组合对烧伤患者供皮区创面微环境的影响

Objective To investigate the effect of dressing materials in various combinations on bum wound microenvironment and healing condition. Methods Two hundred donor sites with wounds of 0.3 mm in depth in 186 burn patients, who needed skingrafting and admitted to our ward were enrolled in study, and they were divided into A ( with dressing composed of aiginate + cotton pad for donor area), B ( with dressing composed of vaseline gauze + cotton pad for donor area) , C (with dressing composed of algi-nate+ foam dressing for donor area), D ( with dressing composed of vaseline gauze + foam dressing for donor area) groups according to random table method. Effect of dressings on wound evaporation and pH value were observed. Bacterial colonization, degree of pain complained by patients after dressing change, and wound healing time in each group were compared. Results One hundred and eighty-four patients complied with the study, while 2 patients were excluded due to untimely falling-off of the dressing. Wound evaporaton in respectively, among them B group showed optimal effect of keeping humidity (P<0.01). Wound pH value in A, B, C, D groups was 7.22±0.06, 7.41±0.03, 7.05±0.03, 7.34±0.06, respectively, among them it was highest in B group. The positive rate of bacteria in D group was highest (22.4%), and lowest in C group (4.0%). Pain was lightest in C group (score was 0.98±0.12), and most serious in B group ( score was 8.14±0.82). The shortest wound healing time was seen in C group (6.7±0.8 d) , and longest in D group (15.6±3.5 d). Conclusions Application of various dressings on similar wounds can pro-duce different wound microenvironment, which is closely related to wound healing time. Compared with pH value, humidity is the more important factor for wound healing.     

不同敷料组合对烧伤患者供皮区创面微环境的影响

Objective To investigate the effect of dressing materials in various combinations on bum wound microenvironment and healing condition. Methods Two hundred donor sites with wounds of 0.3 mm in depth in 186 burn patients, who needed skingrafting and admitted to our ward were enrolled in study, and they were divided into A ( with dressing composed of aiginate + cotton pad for donor area), B ( with dressing composed of vaseline gauze + cotton pad for donor area) , C (with dressing composed of algi-nate+ foam dressing for donor area), D ( with dressing composed of vaseline gauze + foam dressing for donor area) groups according to random table method. Effect of dressings on wound evaporation and pH value were observed. Bacterial colonization, degree of pain complained by patients after dressing change, and wound healing time in each group were compared. Results One hundred and eighty-four patients complied with the study, while 2 patients were excluded due to untimely falling-off of the dressing. Wound evaporaton in respectively, among them B group showed optimal effect of keeping humidity (P<0.01). Wound pH value in A, B, C, D groups was 7.22±0.06, 7.41±0.03, 7.05±0.03, 7.34±0.06, respectively, among them it was highest in B group. The positive rate of bacteria in D group was highest (22.4%), and lowest in C group (4.0%). Pain was lightest in C group (score was 0.98±0.12), and most serious in B group ( score was 8.14±0.82). The shortest wound healing time was seen in C group (6.7±0.8 d) , and longest in D group (15.6±3.5 d). Conclusions Application of various dressings on similar wounds can pro-duce different wound microenvironment, which is closely related to wound healing time. Compared with pH value, humidity is the more important factor for wound healing.     

不同敷料组合对烧伤患者供皮区创面微环境的影响

Objective To investigate the effect of dressing materials in various combinations on bum wound microenvironment and healing condition. Methods Two hundred donor sites with wounds of 0.3 mm in depth in 186 burn patients, who needed skingrafting and admitted to our ward were enrolled in study, and they were divided into A ( with dressing composed of aiginate + cotton pad for donor area), B ( with dressing composed of vaseline gauze + cotton pad for donor area) , C (with dressing composed of algi-nate+ foam dressing for donor area), D ( with dressing composed of vaseline gauze + foam dressing for donor area) groups according to random table method. Effect of dressings on wound evaporation and pH value were observed. Bacterial colonization, degree of pain complained by patients after dressing change, and wound healing time in each group were compared. Results One hundred and eighty-four patients complied with the study, while 2 patients were excluded due to untimely falling-off of the dressing. Wound evaporaton in respectively, among them B group showed optimal effect of keeping humidity (P<0.01). Wound pH value in A, B, C, D groups was 7.22±0.06, 7.41±0.03, 7.05±0.03, 7.34±0.06, respectively, among them it was highest in B group. The positive rate of bacteria in D group was highest (22.4%), and lowest in C group (4.0%). Pain was lightest in C group (score was 0.98±0.12), and most serious in B group ( score was 8.14±0.82). The shortest wound healing time was seen in C group (6.7±0.8 d) , and longest in D group (15.6±3.5 d). Conclusions Application of various dressings on similar wounds can pro-duce different wound microenvironment, which is closely related to wound healing time. Compared with pH value, humidity is the more important factor for wound healing.     

不同敷料组合对烧伤患者供皮区创面微环境的影响

Objective To investigate the effect of dressing materials in various combinations on bum wound microenvironment and healing condition. Methods Two hundred donor sites with wounds of 0.3 mm in depth in 186 burn patients, who needed skingrafting and admitted to our ward were enrolled in study, and they were divided into A ( with dressing composed of aiginate + cotton pad for donor area), B ( with dressing composed of vaseline gauze + cotton pad for donor area) , C (with dressing composed of algi-nate+ foam dressing for donor area), D ( with dressing composed of vaseline gauze + foam dressing for donor area) groups according to random table method. Effect of dressings on wound evaporation and pH value were observed. Bacterial colonization, degree of pain complained by patients after dressing change, and wound healing time in each group were compared. Results One hundred and eighty-four patients complied with the study, while 2 patients were excluded due to untimely falling-off of the dressing. Wound evaporaton in respectively, among them B group showed optimal effect of keeping humidity (P<0.01). Wound pH value in A, B, C, D groups was 7.22±0.06, 7.41±0.03, 7.05±0.03, 7.34±0.06, respectively, among them it was highest in B group. The positive rate of bacteria in D group was highest (22.4%), and lowest in C group (4.0%). Pain was lightest in C group (score was 0.98±0.12), and most serious in B group ( score was 8.14±0.82). The shortest wound healing time was seen in C group (6.7±0.8 d) , and longest in D group (15.6±3.5 d). Conclusions Application of various dressings on similar wounds can pro-duce different wound microenvironment, which is closely related to wound healing time. Compared with pH value, humidity is the more important factor for wound healing.     

不同敷料组合对烧伤患者供皮区创面微环境的影响

Objective To investigate the effect of dressing materials in various combinations on bum wound microenvironment and healing condition. Methods Two hundred donor sites with wounds of 0.3 mm in depth in 186 burn patients, who needed skingrafting and admitted to our ward were enrolled in study, and they were divided into A ( with dressing composed of aiginate + cotton pad for donor area), B ( with dressing composed of vaseline gauze + cotton pad for donor area) , C (with dressing composed of algi-nate+ foam dressing for donor area), D ( with dressing composed of vaseline gauze + foam dressing for donor area) groups according to random table method. Effect of dressings on wound evaporation and pH value were observed. Bacterial colonization, degree of pain complained by patients after dressing change, and wound healing time in each group were compared. Results One hundred and eighty-four patients complied with the study, while 2 patients were excluded due to untimely falling-off of the dressing. Wound evaporaton in respectively, among them B group showed optimal effect of keeping humidity (P<0.01). Wound pH value in A, B, C, D groups was 7.22±0.06, 7.41±0.03, 7.05±0.03, 7.34±0.06, respectively, among them it was highest in B group. The positive rate of bacteria in D group was highest (22.4%), and lowest in C group (4.0%). Pain was lightest in C group (score was 0.98±0.12), and most serious in B group ( score was 8.14±0.82). The shortest wound healing time was seen in C group (6.7±0.8 d) , and longest in D group (15.6±3.5 d). Conclusions Application of various dressings on similar wounds can pro-duce different wound microenvironment, which is closely related to wound healing time. Compared with pH value, humidity is the more important factor for wound healing.     

不同敷料组合对烧伤患者供皮区创面微环境的影响

Objective To investigate the effect of dressing materials in various combinations on bum wound microenvironment and healing condition. Methods Two hundred donor sites with wounds of 0.3 mm in depth in 186 burn patients, who needed skingrafting and admitted to our ward were enrolled in study, and they were divided into A ( with dressing composed of aiginate + cotton pad for donor area), B ( with dressing composed of vaseline gauze + cotton pad for donor area) , C (with dressing composed of algi-nate+ foam dressing for donor area), D ( with dressing composed of vaseline gauze + foam dressing for donor area) groups according to random table method. Effect of dressings on wound evaporation and pH value were observed. Bacterial colonization, degree of pain complained by patients after dressing change, and wound healing time in each group were compared. Results One hundred and eighty-four patients complied with the study, while 2 patients were excluded due to untimely falling-off of the dressing. Wound evaporaton in respectively, among them B group showed optimal effect of keeping humidity (P<0.01). Wound pH value in A, B, C, D groups was 7.22±0.06, 7.41±0.03, 7.05±0.03, 7.34±0.06, respectively, among them it was highest in B group. The positive rate of bacteria in D group was highest (22.4%), and lowest in C group (4.0%). Pain was lightest in C group (score was 0.98±0.12), and most serious in B group ( score was 8.14±0.82). The shortest wound healing time was seen in C group (6.7±0.8 d) , and longest in D group (15.6±3.5 d). Conclusions Application of various dressings on similar wounds can pro-duce different wound microenvironment, which is closely related to wound healing time. Compared with pH value, humidity is the more important factor for wound healing.     

The Meek micrograft technique for burns; review on its outcomes: Searching for the superior skin grafting technique

IntroductionAutologous split thickness skin grafting is the standard-of-care for the majority of deep dermal and full thickness burns: Meshed grafting is most commonly used. Patients with extensive burn injuries have limited donor site availability. Meek micrografting is a well-known technique to enable larger expansions. A review was conducted on the outcomes of the Meek micrograft technique.MethodA database search in PubMed, Web of Science, Google Scholar and the Cochrane Library was conducted from the first Meek micrografting report in 1958 until 2021, including terms ‘burns’, ‘micrografting’ and/or ‘Meek’. Original papers reporting outcomes of Meek micrografting were included.Results1529 papers were identified and eventually 15 articles were included, the majority classified as poor quality according to Chambers criteria. 310 patients with 56% mean TBSA were described. Weighted averages were calculated for ‘graft take’ 82 ± 7%, ‘time to wound closure’ 53 ± 20 days and ‘length of hospital stay’ 61 ± 31 days. Scar quality was minimally described and often poorly assessed. Limited data were available on outcomes ‘donor site size’, ‘number of operations’, ‘cost effectiveness’ and ‘bacterial load/wound infection rate’.ConclusionOverall poor study quality and the specific lack of data on scar quality, made it impossible to draw conclusions on the outcomes of Meek micrografting. A randomized controlled trial is required to further investigate the performance of the Meek micrograft technique.     

水胶体敷料在大面积烧伤患者中的应用效果及促进创面愈合机制探讨

目的:分析水胶体敷料在大面积烧伤患者中的应用效果及其促进创面愈合机制。方法:选择笔者医院2018年1月-2019年6月收治的200例大面积烧伤患者,以随机数表法分为采取纱布加压包扎的对照组以及采取水胶体敷料包扎的观察组,各100例,两组均接受Meek植皮术治疗,对两组创面愈合时间、创面细菌定量、炎性细胞因子(C反应蛋白、白介素6、转化生长因子-β1)、血管新生指标(血管内皮生长因子、碱性成纤维细胞生长因子)进行比较。结果:观察组创面愈合时间(19.85±1.15)d,短于对照组(25.50±1.50)d,创面细菌定量(420.25±15.20)cfu/g小于对照组(877.50±15.35)cfu/g,差异有统计学意义(t=29.893、211.667,P均=0.000)。治疗后观察组C反应蛋白(9.25±1.05)mg/L、白介素6(71.10±12.10)ng/L、转化生长因子-β1(9.33±1.17)μg/L,低于对照组(12.11±1.08)mg/L、(84.88±12.82)ng/L、(12.14±1.12)μg/L,差异有统计学意义(t=18.987、77.245、17.349,P均=0.000)。观察组血管内皮生长因子(140.29±1.61)ng/L、碱性成纤维细胞生长因子(88.92±1.18)ng/L,高于对照组(124.38±1.52)ng/L、(79.86±1.24)ng/L,差异有统计学意义(t=71.856、52.929,P均=0.000)。结论:在大面积烧伤患者治疗中水胶体敷料能够通过抑制炎症反应、促进血管新生来促进创面愈合,值得在今后临床治疗工作中推广使用。     

不同敷料对深度烧伤创面植皮后愈合情况的影响对比

目的:对比分析不同敷料对深度烧伤创面植皮后愈合情况的影响。方法:选取我院于2011年5月～2012年5月收治的69例深度烧伤并接受创面植皮的患者,选择患者身上2处大小为1%的邻近创面,将创面内层覆盖物为聚酰胺薄纱的所有创面作为实验组,内层覆盖物为凡士林油纱的创面作为对照组。对比分析两组术后的创面蒸发量、不同时间点的创面愈合率、创面愈合时间及换药时的疼痛情况。结果:术后5天,实验组内层敷料表面的蒸发量要明显少于对照组[(25.3±6.1)ml.h-.1m-2vs(35.8±4.9)ml.h-.1m-2t=11.147 P<0.05],所有患者内层敷料表面的蒸发量要显著少于裸露创面(P<0.05),但高于正常皮肤表面(P<0.05);实验组术后10天,15天及20天的创面愈合率均高于对照组[(81.2±19.5,95.3±9.4,99.8±0.4)%vs(72.4±7.6,84.6±10.4,97.2±2.3)%t=3.493,6.340,9.251 P<0.05],且创面完全愈合时间要显著短于对照组[(14.1±2.0)天vs(17.2±2.5)天t=8.043 P<0.05];实验组术后5天换药及揭除内层敷料时的VAS评分要明显低于对照组[(3.3±0.7,5.0±0.6)vs(4.9±0.4,7.9±0.5),t=16.485,30.843 P<0.05]。结论:相比与传统的凡士林油纱,聚酰胺薄纱更有利于深度烧伤创面植皮后的愈合,且减轻了患者换药时的疼痛,值得推广。     

Prospective observational study comparing burn surgeons’ estimations of wound healing after skin grafting to photo-assisted methods

IntroductionAppropriate graft healing after split-thickness skin graft and early recognition of complications (graft loss) are critical to burn patient management. Larger mesh ratio expansions and Meek micrografting may pose a greater challenge in estimating the percentage of wound healing. This study looks at the reliability of photograph assessments and the concordance of bedside evaluation to photograph assessments of wound healing after skin grafting.MethodsThree assessment methods for percentage of wound healing after skin Grafting were assessed: (1) clinicians’ bedside rating, (2) clinician assessment of high-definition photographs, and (3) digital image analysis through color subtraction using Adobe Photoshop. We compared each method using a mixed-effects model on absolute agreement using intra-class correlation (ICC) and Bland Altman (BA) plots.ResultsFourteen burn patients were enrolled with 38 grafted wounds (100 sites). Bedside assessments had a mean ICC of 0.64 (compared to digital image analysis) and 0.69 (compared to photo assessment), with a wide range on BA-plots. Inter-rater reliability of photo assessment was excellent (0.96) among six clinicians. Repeated photo-assisted assessments had good intra-rater reliability (ICC: photo assessment: 0.88; digital analysis: 0.97).ConclusionsBedside wound healing assessments show variability; photograph documentation of sequential wound progression could supplement active clinical management or studies for more reliable assessments.     

A porcine model of full-thickness burn, excision and skin autografting

Acute burn wounds often require early excision and adequate coverage to prevent further hypothermia, protein and fluid losses, and the risk of infection. Meshed autologous skin grafts are generally regarded as the standard treatment for extensive full-thickness burns. Graft take and rate of wound healing, however, depend on several endogenous factors. This paper describes a standardized reproducible porcine model of burn and skin grafting which can be used to study the effects of topical treatments on graft take and re-epithelialization.Procedures provide a protocol for successful porcine burn wound experiments with special focus on pre-operative care, anesthesia, burn allocation, excision and grafting, postoperative treatment, dressing application, and specimen collection. Selected outcome measurements include percent area of wound closure by planimetry, wound assessment using a clinical assessment scale, and histological scoring.The use of this standardized model provides burn researchers with a valuable tool for the comparison of different topical drug treatments and dressing materials in a setting that closely mimics clinical reality.     

CGF在多种类型创面修复中的临床应用

目的:探讨CGF(浓缩生长因子)在多种类型创面修复中的临床应用价值。方法:30例创面患者,随机分为CGF组与对照组,两组各包括6例慢性溃疡,5例皮肤软组织坏死,4例浅Ⅱ度伴部分深Ⅱ度烧伤,对照组采用清创去除坏死组织、抗生素抗感染、活血化瘀、换药等常规处理,CGF组在上述常规治疗的基础上同时行液态CGF注射和(或)湿敷及凝胶态CGF膜覆盖和(或)填塞治疗。运用SPSS 19.0软件进行统计学分析,对比两组创面愈合时间及瘢痕外形满意度。结果:CGF组慢性溃疡(14.83±2.93)d痊愈,对照组(32.00±3.58)d痊愈;CGF组皮肤软组织坏死(7.40±1.34)d痊愈,对照组(16.80±2.39)d痊愈;CGF组浅Ⅱ度伴部分深Ⅱ度烧伤9d痊愈,对照组(18.75±2.87)d痊愈。所有CGF组创面愈合时间均短于对照组,差异具有统计学意义(P<0.05)。CGF组术后外形总体满意率为100.00%(15/15),对照组为53.33%(8/15)。结论:不同性状CGF联合应用能有效促进创面愈合,加快创面愈合速度,提高创面愈合质量,控制感染,减轻瘢痕形成,且制备简单,操作便捷,在临床创面修复中具有很高的应用价值及前景。     

银离子藻酸盐敷料在儿童四肢深II度烧伤创面中的应用效果观察

目的:探讨藻酸盐银离子敷料治疗儿童深II度烧伤创面中临床效果.方法:选取2015年7月—2016年5月我院烧伤整形科收治的四肢深II度烧伤患儿共60例,随机分为观察组和对照组.在创面清创后,观察组外用藻酸盐银离子敷料覆盖,无菌纱布包扎;对照组采用银锌霜皮肤黏膜抗菌剂涂抹,无菌纱布包扎.两组均根据创面渗出情况换药.比较两组患儿的换药次数、入院第7天的发热率、创面愈合率及愈合时间.结果:与对照组相比,观察组换药次数(8.63±2.37)次,明显少于对照组(14.70±2.30)次,差异有统计学意义(P<0.05).观察组治疗第7天患儿发热率为6.67%(2例),明显低于对照组23.33%(7例),差异有统计学意义(P<0.05);观察组治疗第7、11、15和19天创面愈合率明显高于对照组,差异有统计学意义(P<0.05);观察组创面愈合时间为(20.70±2.30)d,住院时间为(21.33±3.67)d,均较对照组[(27.63±3.63)d和(28.30±3.30)d]缩短,差异具有统计学意义(P<0.05).结论:应用银离子藻酸盐敷料治疗儿童四肢深II度烧伤创面能减少换药次数,加速创面愈合,减少患者痛苦,值得推广和应用.     

早期电动磨痂结合不同种敷料覆盖修复小儿深Ⅱ度烧伤创面的疗效观察

目的：观察小儿深Ⅱ度烧伤创面早期电动磨痂后结合不同种敷料覆盖的治疗效果.方法：将2010年1月-2012年1月收治的60例四肢和躯干热液烫伤患儿随机分为凡士林油纱组、生物敷料组和负压封闭引流（VSD）组,每组20例.各组患儿在磨痂后,根据分组的不同,分别应用凡士林油纱、异种脱细胞真皮基质或VSD覆盖创面.术后观察创面愈合时间、愈合质量、换药次数、治疗费用.结果：生物敷料组、VSD组的创面愈合时间分别为（16.3±1.9）d和（16.9±1.8）d,明显短于凡士林纱布组[（19.2±2.5）d,P＜0.05];生物敷料组、VSD组反映瘢痕增生程度的温哥华评分分别为（4.5±0.7）分和（4.1±0.8）分,明显低于凡士林油纱组[（8.6±1.2）分,P＜0.01];VSD组的换药次数[（3.0±0.5）次]明显低于凡士林油纱组[（6.9±0.7）次,P＜0.05]和生物敷料组[（7.2±0.8）次,P＜0.01];凡士林油纱组的住院费用[（6 560.34±1 230.00）元],明显低于生物敷料组[（12 028.24±1 380.00）元,P＜0.01]和VSD组[（14 125.40±1 560.00）元,P＜0.01].结论：早期磨痂应用异种生物敷料和VSD覆盖较普通油纱覆盖能明显促进小儿深Ⅱ度烧伤创面愈合,缩短住院时间,显著提高创面愈合质量,减少换药次数,减轻患儿痛苦,但住院费用较高,临床上应根据患儿具体情况,灵活选择磨痂后创面覆盖物.     

"Shift to right flypaper technique" a refined method for postage stamp autografting preparation

"Lack of donor skin" is a challenge condition for autografting in the treatment of extensive burns. The modified Meek technique seems to be a practical solution for this problem. However, the equipment and consumed materials for the modified Meek technique are expensive which limits routine use. Designing a less expensive, efficient and easy to apply expansion method may improve burn care quality and shorten hospital stay period. Our previous study reported the "flypaper technique" for preparation of postage stamp autografting. The time for confluence of the burned wound depends on the size of the skin islands and expansion ratio. In clinical practice, 5mm skin squares is the preferred size of the skin islands; however, the positioning procedure can be modified to improve the wound healing process. According to the chessboard diagram, the "shift to right" positioning technique shortens the 10% biggest distance in six times expansion diagrams and 20% biggest distance in nine times expansion diagrams. By using a quick cutting plate, chessboard tray and petrolatum gauze, the skin islands can be uniformly located and correctly oriented on the gauze. This method allows a true expansion ratio up to nine times. In comparison with the modified Meek technique, this method also offers rapid wound reepithilization but with lower cost. However, the burn scar needs further rehabilitation and compression therapy to improve the functional and cosmetic result. This "shift to right flypaper technique" is worthy of consideration in dealing with extensive burns.     

"Flypaper technique" a modified expansion method for preparation of postage stamp autografts

The gold standard for management of extensive burn has been early excision, temporary allografting and final autografting. However, "lack of donor skin" is a challenge condition when autografting in the treatment of extensive burns. Designing an efficient and easy to apply expansion method may improve burn care quality and shorten the hospital stay period. From December 1998 to May 2004, we have performed fly paper technique postage stamp skin autografting for eight major burn patients in the Kaohsiung Medical University Hospital. By using a quick cutting plate, chessboard tray and petrolatum gauze, the skin islands can be uniformly located and correctly oriented on gauze. Then, the gauze with skin islands was grafted on to the wound. The wound healing time depends on the size of skin islands and expansion ratio. This method allows true expansion ratio up to nine times. The average wound healing times are 27.2 days for six times expansion and 34 days for nine times expansion. However, the burn scar needs further compression therapy to improve the cosmetic result. In comparison with the mesh technique, the skin islands are independent of each other, any dislodgement of a skin island will not interfere with the surrounding skin squares. When compared with the modified Meek technique, this method also offers rapid wound reepithilization but with lower cost. This flypaper technique is worthy of consideration in dealing with the extensive burns.