Meek植皮术和微粒皮移植术治疗特大面积深度烧伤患者的效果比较

目的:比较Meek植皮术和微粒皮移植术治疗特大面积深度烧伤患者的效果。方法:回顾性分析2018年6月至2020年6月该院烧伤科收治的100例特大面积深度烧伤患者的临床资料,按手术方法不同分为对照组和研究组各50例。对照组采用微粒皮移植术,研究组采用Meek植皮术。比较两组植皮效果、手术相关指标(手术时间、创面愈合时间、住院时间和治疗费用)、患者满意度和并发症发生率。结果:研究组植皮优良率为90.00%(45/50),显著高于对照组的56.00%(28/50),植皮达优率为60.00%(30/50),显著高于对照组的20.00%(10/50),差异均有统计学意义(P<0.05);研究组手术时间、住院时间、创面愈合时间均显著短于对照组,治疗费用和并发症发生率均低于对照组,差异有统计学意义(P<0.05);研究组满意度为96.00%(48/50),显著高于对照组的76.00%(38/50)。结论:Meek植皮术治疗特大面积深度烧伤患者的效果优于微粒皮移植术,能缩短手术时间、创面愈合时间和住院时间,降低并发症发生率和治疗费用,且患者满意度较好。     

皮肤移植新进展

断层皮片移植是目前临床治疗大面积皮肤缺损的重要方法。然而,大面积烧伤患者自体皮源严重不足,取皮引起供皮区损伤甚至残留瘢痕等问题限制了断层皮片移植的临床应用。为解决上述问题,一些新的皮肤移植技术开始出现,包括负压吸疱表皮移植、自体表皮细胞悬液移植、Xpansion微粒皮移植、点阵全层皮肤移植以及新型组织工程皮肤制备与移植等。这些技术在扩大皮片覆盖面积、减少供皮区损伤等方面取得了较大进展,上述技术可以单独在临床上应用或与断层皮片移植联合使用,以减轻断层皮片移植带来的相关并发症,但上述技术仍需进一步的临床研究和实验,以更好地应用于临床实践。     

大面积深度烧伤应用混合皮肤嵌植与微粒皮移植的比较

目的 了解大而积深度烧伤后混合皮肤嵌植与微粒皮移植疗效的差异. 方法 回顾性总结笔者单位1992-2008年17年间收治的101例大面积深度烧伤患者临床资料.将患者分为混合嵌植组52例、微粒皮组49例.比较2组患者首次自体供皮面积、首次自体皮覆盖创面面积,首次自体皮移植成活率、自体皮理论扩展倍数、自体皮实际扩展倍数、自体供皮总面积,以及术后残余创面情况、大关节功能状况等. 结果 混合嵌植组、微粒皮组的首次自体供皮面积分别为(3.25±0.48)%、(3.01±0.21)%TBSA,首次自体皮覆盖创面面积分别为(30.4±3.6)%、(41.4±1.3)%TBSA,首次自体皮移植成活率分别为(99.9±1.9)%、(87.5±6.8)%,自体皮理论扩展倍数分别为(9.5±1.3)、(13.9±1.4)倍,自体皮实际扩展倍数分别为(9.5±1.3)、(12.0±1.5)倍,上述指标组间比较,差异均有统计学意义(P<0.05);混合嵌植组、微粒皮组自体供皮总面积分别为(14.2±1.9)%、(14.0±2.1)%TBSA,2组比较,差异无统计学意义(P>0.05).混合嵌植组、微粒皮组残余创面超过0.5%TBSA者分别有23例占44.2%、37例占75.5%;混合嵌植组大关节功能状况较好者34例占65.4%,微粒皮组18例占36.7%. 结论 微粒皮移植法自体皮扩展倍数明显大于混合嵌植法,能更充分利用有限皮源;混合嵌植法创而愈合质量和大关节功能恢复状况优于微粒皮移植法.     

多种方法联合治疗压疮晚期肉芽创面临床体会

目的总结分析湿润烧伤膏换药、负压封闭引流、自体微粒皮种植联合治疗压疮晚期肉芽创面的临床疗效。方法2017年2月至2018年6月中铁十二局集团中心医院创面修复科收治的10例压疮患者在营养支持、抗感染、肢体康复锻炼等综合治疗以及健康宣教、饮食指导等综合护理的基础上,予以其晚期肉芽创面湿润烧伤膏换药、负压封闭引流、自体微粒皮种植联合治疗,观察治疗效果。结果 10例压疮患者的晚期肉芽创面均完全愈合,愈合时间为45～70 d;出院后随访3～12个月,愈后皮肤生长良好,均未复发。结论湿润烧伤膏换药、负压封闭引流、自体微粒皮种植联合治疗压疮晚期肉芽创面,可有效促进创面愈合,疗效显著,值得进一步探索推广。     

微粒皮肤移植治疗特大面积烧伤：附7例报告

报告应用微粒皮肤移植技术抢救成功７例特大面积烧伤病人。文中介绍了手术方法、注意事项，指出了本术式的优缺点，并对该领域国内外的发展状况，作了简单叙述。     

Microskin autografting in the treatment of burns over 70% of total body surface area: 14 years of clinical experience

Despite the fact that early excision and grafting have significantly improved burn outcomes, the management of severely burned patients whose burn size exceeds 70% total body surface area (TBSA) still represents a big challenge for burn surgeons all over the world. During the period of 1997-2010 at our centre, aggressive excision and microskin autografting were performed in 63 severely burned patients. Their burn sizes ranged from 70% to 98% TBSA with a mean of 84.9%. The average full-thickness burn was 66.3% (range, 29-94%). Thirty patients had concomitant inhalation injury. Two to 7 days after burn, these patients underwent aggressive excisions ranging from 25% to 60% TBSA and transplantation of microskin autograft overlaid with allograft. The ratios of donor-site to recipient-site surface area were between 1:6 and 1:18. Signs of epithelialization were shown within 35-55 days. The wound healing rate was 74.9% (176/235), with 51.1% of cases (120/235) healing completely and 23.8% (56/235) improving. Microskin autografting yielded an overall survival rate of 63.5%; only 23 patients died. Our clinical experience in using the microskin autografting for burn coverage suggests that the technique is very effective in covering extensive burns, and that it is particularly useful when graft donor sites are very limited due to its high utilization rate of donor site. The factors affecting the outcome of microskin autografting are discussed herein.     

羧甲基壳聚糖膜促进大鼠微粒皮移植创面愈合的实验研究

目的：本研究旨在评估羧甲基壳聚糖膜取代异体皮作为微粒皮移植载体促进创面愈合的作用。方法28只大鼠中,每次随机抽取2只大鼠配对同时手术,在大鼠背部两侧制作直径25 mm、对称圆形全层皮肤缺损创面各1个,两侧创面分别设为实验组和对照组,均移植自体微粒皮,对照组创面覆盖相互配对大鼠的异体皮,实验组创面覆盖羧甲基壳聚糖膜。于术后7、11、14 d 观察记录各组创面愈合时间,并于术后7、14、19 d 采集创面组织行组织病理学检查。结果实验组的羧甲基壳聚糖膜覆盖下微粒皮能够成活,且能修复创面。实验组创面平均愈合时间为（15.6±2.0）d,短于对照组创面平均愈合时间为（18.8±1.9）d,两组比较,差异有统计学意义（t =8.987,P〈0.05）。组织切片结果显示：羧甲基壳聚糖膜覆盖下微粒皮修复的新生表皮层生长较异体皮覆盖下新生表皮厚。结论羧甲基壳聚糖膜作为生物敷料,能够有效地保护创面,提供微粒皮修复创面的微环境。可用于取代异体皮覆盖微粒皮移植的创面。     

富血小板血浆联合微粒皮移植在高原地区老年慢性小创面中的临床研究

目的探究在高原地区老年慢性小创面治疗中使用富血小板血浆(PRP)联合微粒皮移植的治疗效果。 方法选取2018年2月至2022年2月青海省人民医院烧伤整形科收治的老年慢性小创面患者60例。根据患者入院时间不同将患者分为观察组和对照组,观察组采用PRP联合微粒皮移植,对照组采用PRP联合刃厚邮状皮移植。采集患者的外周静脉血,采用二次离心法制备PRP;2组患者均于局部浸润麻醉下应用电动取皮机自大腿前内侧根据创面需要取合适大小刃厚皮片,皮片厚度约0.2 mm,观察组供受区比例为1∶4~1∶8,将所取皮片剪碎后切割成直径<1 mm²的微粒皮备用;对照组供受区比例为1∶1~1∶2,将所取皮片制备为大小约1 cm×1 cm的刃厚邮状皮备用。创面清创、止血后,观察组将制备好的微粒皮均匀涂抹在创面后以PRP填充创面,用聚氨酯泡沫敷料或凡士林纱布覆盖创面避免PRP流失及失活,清洁敷料覆盖并固定;对照组将制备好的PRP填充于创面,再将制备好的刃厚邮状皮片移植于PRP之上,用凡士林或聚氨酯泡沫敷料覆盖清洁敷料加压包扎。2组术后均常规行抗感染等治疗,术后第6、11、16、21、26天创面换药,直至创面完全愈合。术后第21天,统计2组患者的治疗有效率;统计2组患者的创面愈合时间;创面愈合后6个月,以温哥华瘢痕评估量表(VSS)对2组患者的瘢痕情况进行评估。数据比较采用Mann-Whitney U检验和χ²检验。 结果术后第21天,观察组治疗有效27例,无效3例,治疗有效率为90.00%;对照组治疗有效20例,无效10例,治疗有效率为66.67%,2组比较差异有统计学意义(χ²＝6.278,P＝0.043)。观察组创面愈合时间为为26.0(24.0, 27.0) d,短于对照组[43.0(39.8, 47.3) d],2组比较差异有统计学意义(Z＝－6.531,P<0.05)。创面愈合后6个月,观察组VSS评分中色素沉着、瘢痕厚度、血管分布和柔韧性评分分别为0(0, 0)、0(0, 0)、0(0, 0)、1(0, 1)分,均分别低于对照组[2.0(1.0, 2.3)、1.5(0.8, 2.0)、1(1, 2)、2(1, 3)分],2组比较差异均有统计学意义(Z＝－6.310、－4.838、－5.624、－4.431,P<0.05)。 结论在高原地区,对于老年慢性小创面的治疗,PRP联合微粒皮移植的创新技术具有提高治疗有效率、缩短创面愈合时间的疗效,为患者提供更多治愈的选择性。     

A new method of microskin autografting with a Vaseline-based moisture dressing on granulation tissue

In the conventional method of microskin autografting, aggressive early excision is adopted, followed by coverage with a microskin–allograft complex to close extensive burn wounds. However, early excision is always associated with a defect of viable tissue, resulting in massive blood loss and causing high risk to aged patients or those with other systemic diseases. We developed a new method in which an eschar thinning operation was first adopted, followed by raising granulation tissue and microskin autografting, which was covered by a Vaseline-based moisture dressing. A total of 52 patients were included in this study and randomly assigned to the control group (n = 26) and the experimental group (n = 26) for the conventional method and the new method, respectively. The re-epithelisation rate on the 21st day after autografting indicated that there was no significant difference between both groups. There was also no significant difference between the two groups when the re-epithelialisation rate was compared with the type of organisms cultured. However, the Vancouver Burn Skin Score (VBSS) results demonstrated a significant improvement of cosmetic appearance in the experimental group (score = 2.1) as compared to the control group (score = 3.9). The new method also showed other advantages, including less blood loss, shorter surgical duration and lower cost of surgery. From this prospective study, it can be concluded that the new method can be an alternative to the conventional microskin autografting procedure.     

微粒皮肤移植术的历史、现状和未来

微粒皮肤移植术已在我国应用33年,到目前为止,这项技术依然是大面积深度烧伤特别是Ⅲ度烧伤面积大于80%总体表面积患者的最佳治疗方法之一。本文回顾和分析了微粒皮肤移植术的发明历史、优点和不足、方法的改进,并提出了微粒皮肤移植术的现实意义和对这项技术今后发展的展望。