人工真皮支架早期修复特重烧伤手足深度创面

目的 与传统的切削痂自体中厚皮移植术相比,探讨切削痂人工真皮支架植入术+自体刃厚皮移植术修复特重烧伤患者手足深度创面的疗效.方法 选择2012年3月至2015年3月第二军医大学长海医院烧伤外科收治的有手足深度创面的特重烧伤患者作为研究对象.符合纳入标准的28例患者按手术方法不同分为两组,观察组(14例)在伤后第4～7天行四肢深度创面切削痂、生物敷料覆盖+手足创面切削痂、人工真皮支架植入术,伤后第21～28天行手足创面自体刃厚皮移植术;对照组(14例)在伤后第4～7天行四肢深度创面切削痂、生物敷料覆盖术,手足深度创面以保痂换药为主,第28～35天行手足深度创面切削痂自体中厚皮移植术.记录每次手术持续时间、植皮成活情况、皮片坏死的原因、供皮区愈合时间、能否再次供皮、随访手足瘢痕增生情况.结果 观察组第1次手术持续时间(h)与对照组比较差异无统计学意义[(4.50±0.76) vs(4.14±0.86),P＞0.05];第2次手术持续时间(h)少于对照组[(2.11±0.35) vs (3.39±0.49),P＜0.001].植皮术后第8天打开换药时,观察组皮片全部成活者占97.37％(37/38),创面出现感染者占2.63％(1/38);对照组皮片全部成活者占73.68％(28/38),部分成活者占23.68％(9/38),创面感染者占2.63％(1/38).观察组供皮区愈合时间(d)少于对照组[(6.07±0.83) vs(14.64±0.93),P＜0.001].经评估观察组可再次供皮者占78.57％(11/14),对照组可再次供皮者占14.29％(2/14,P＜0.05).随访1年,根据温哥华瘢痕量表评分(分)观察组手足瘢痕增生情况好于对照组[(5.07±1.21) vs (8.07±1.14),P＜0.001].结论应用人工真皮支架能早期修复特重烧伤手足深度创面,不需额外增添手术操作时间,植皮成活情况及远期活动功能可,对供皮区损伤小.

Early application of artificial dermis scaffold in repairing deep wounds on hands and feet after extensive burn

Objective To investigate the clinical efficacy of artificial dermis scaffold combined with autologous split-thickness skin graft in repairing deep wounds on hands and feet after extensive burn by comparing with the traditional ways. Methods The patients with deep wounds on hands and feet, who were treated in Department of Burn Surgery, Changhai Hospital, Second Military Medical University from March 2012 to March 2015, were selected as participants. A total of 28 patients meeting the inclusion criteria were allocated into two groups according to the operations. The observation group (14 cases) received artificial dermis scaffold after crust resectional therapy at 4-7 days after burns, and they also received autologous split-thickness skin graft following crust resectional therapy at 21-28 days after burns. The control group (14 cases) received changing medicine to maintain the scab following crust resectional therapy at 4-7 days after burns, and they also received autologous split-thickness skin graft following crust resectional therapy at 28-35 days after burns. The following data were recorded: the operation time, survival rate of skin graft, the cause of the flap necrosis, healing time of donor site and whether it could donor more flap or not, and the hyperplastic scars on hands and feet. Results The observation group needed similar operation time when compared with the control group for the first operation ([4.50±0.76] h vs[4.14±0.86] h,P>0.05), while the second operation time of the observation group was significantly shorter than that of the control group ([2.11±0.35] h vs [3.39±0.49] h, P<0.001). When changing the medicine at the 8^th day after skin grafting, the survival rate of skin graft in the observation group was 97.37%(37/38) and the infection rate was 2.63%(1/38); the survival rate of the whole skin graft in control group was 73.68%(28/38), and that of partial skin graft was 23.68%(9/38), with an infection rate of 2.63%(1/38). The healing time of donor site in the observation group was significantly shorter than that of the control group([6.07±0.83] d vs [14.64±0.93] d, P<0.001). And it was estimated that 78.57%(11/14) of the patients in the observation group and 14.29%(2/14) of patients in the control group could donor more graft(P<0.05). One year follow-up showed that hyperplastic scars on hands and feet in the observation group was significantly better than those in the control group according to the Vancouver Scar Scale (VSS, [5.07±1.21] vs [8.07±1.14], P<0.001). Conclusion Artificial dermis scaffold can be used at early time in repairing deep wounds on hands and feet after extensive burn, with no need for additional operation time; and both the survival rate of skin graft and long-term function are good, with less damage to the donor site.