人工真皮支架在大面积撕脱伤救治中的应用

目的 研究人工真皮支架在大面积撕脱伤救治中的应用。方法 回顾性分析第二军医大学长海医院烧创伤外科2011年1月至2014年12月收治的大面积撕脱伤患者20例，年龄6~68岁，撕脱面积占总体表面积（total body surface area，TBSA）10%~40%。按照治疗方法不同将患者分为两组，每组各10例，对照组患者一期行清创+负压引流术，二期行取植皮术；治疗组患者一期行清创+真皮支架+负压引流术，5~7 d后更换负压装置，观察基底血管化程度，伤后12~14 d行取植皮术。分别统计两组患者从清创到植皮的间隔时间，供皮区愈合时间和愈合质量以及植皮区皮片成活率、愈合时间及愈合质量。结果 与对照组相比，治疗组患者从清创到植皮的间隔时间延长[（13.30±2.06）d vs（7.90±1.10）d，P<0.01]；供皮区愈合时间缩短[（8.10±0.99）d vs（13.10±1.10）d，P<0.01]，供皮区愈合质量提升（4.40±1.58 vs 7.80±1.14，P<0.01）；植皮区皮片成活率[（87.30±5.27）% vs（85.10±5.53）%]、愈合时间[（17.80±1.14）d vs（18.70±2.06）d]、愈合质量（8.40±1.07 vs 9.00±1.05）差异均无统计学意义（P>0.05）。结论 在大面积撕脱伤的治疗过程中早期应用真皮支架联合负压引流技术，可避免在伤后1周左右大范围取皮，手术损伤少，对全身干扰小，可保证患者平稳度过病程早期阶段；同时通过支架自身的血管化可促进创面恢复，减少植皮所需皮片厚度，从而缩短供皮区愈合时间、提高供皮区愈合质量。

Application of artificial dermal scaffold in treatment of large area avulsion injury

Objective To study the application of artificial dermal scaffold in treatment of large area avulsion injury. Methods The clinical data of twenty inpatients with large area avulsion injury who were treated in the Department of Burn and Trauma Surgery of Changhai Hospital between January 2011 and December 2014 were retrospectively analyzed in this study. The 20 patients, aged 6-68 years old and with avulsion area of 10%-40% total body surface area (TBSA), were divided into 2 groups according to treatments, with ten cases in each group. The wounds in the treatment group were treated with debridement plus artificial dermal scaffold plus Negative Pressure Wound Therapy (NPWT); NPWT was changed 5-7 days and the vascularization was observed. The wounds in control group were treated with debridement plus NPWT, and autograft implant surgery was done in both groups according to the vascularization degrees. The time intervals from debridement to skin grafting, the survival rate of the skin-graft, and the healing time and quality of the donor area were all observed. Results Compared with the control group, the treatment group exhibited a significantly longer time interval from debridement to skin grafting([13.30±2.06] d vs[7.90±1.10] d, P<0.05), a significantly shorter healing time ([8.10±0.99] d vs[13.10±1.10] d, P<0.05), and a better healing quality (4.40±1.58 vs 7.80±1.14, P<0.05) in the donor sites. While at the recipient sites, there were no significant differences in the survival rate of the skin-graft([87.30±5.27]% vs[85.10±5.53]%), or the healing time([17.80±1.14] d vs[18.70±2.06] d) and quality(8.40±1.07 vs 9.00±1.05) between the two groups (P>0.05). Conclusion Early application of artificial dermal scaffold combined with NPWT for treatment of large area avulsion injury can avoid large grafting and reduce trauma, which can help to keep patients in stable status; meanwhile it can promote vascularization process and improve the healing time and quality of wounds, especially in the donor sites.