富血小板血浆联合人工真皮/自体超薄皮片治疗难愈性创面

目的：探讨富血小板血浆（platelet?rich plasma，PRP）联合人工真皮/自体超薄皮片治疗难愈性创面的临床疗效。方法：以2017—2019年南通大学附属医院烧伤整形科收治的年龄18~70周岁难愈性创面患者24例作为研究对象，随机分为对照组（人工真皮+自体超薄皮片）及观察组（富血小板血浆联合人工真皮+自体超薄皮片），每组12例。所有患者入院后积极术前准备，在全身状况稳定的情况下对难愈性创面进行彻底清创、止血，观察组行富血小板血浆联合人工真皮支架移植覆盖清创后的肌腱、骨骼外露创面，对照组仅行人工真皮支架移植。2周后行自体超薄皮片移植手术，术后定期换药直至创面愈合。比较两组创面愈合时间和创面愈合后1个月、3个月创面温哥华瘢痕评分（Vancouver scar scale，VSS）情况。结果：观察组创面愈合时间［术后（11.50±0.58）d］相比对照组［术后（13.25±0.58）d］缩短（P＜0.05）。创面愈合后1个月，观察组相比对照组VSS评分明显降低［（5.33±0.33）分vs.（7.75±0.48）分，P＜0.01］；创愈后3个月随访，观察组VSS评分明显低于对照组［（1.83±0.37）分vs.（4.58±0.29）分，P＜0.01］。结论：富血小板血浆联合人工真皮/自体超薄皮片治疗难愈性创面能促进创面愈合、减少色素及瘢痕形成、提高创面愈合质量。

Clinical research for the treatment of refractory wounds with platelet-rich plasma combined with artificial dermis/autologous ultra-thin skin graft

Objective To investigate the clinical efficacy of platelet-rich plasma (PRP) combined with artificial dermis/autologous ultra-thin skin graft in the treatment of refractory wounds. Methods Twenty-four patients with refractory wounds (excluding severe wounds, systemic infections, tumors and other diseases) aged 18-70 years, including 16 males and 8 females, were selected as the study subjects in our department from 2017 to 2019. They were randomly divided into control group (artificial dermis + autologous ultra-thin skin) and observation group (platelet-rich plasma combined with artificial dermis + autologous ultra-thin skin), 12 cases in each group. After admission, all patients were prepared actively before operation to thoroughly debride and stop bleeding in a stable condition. The observation group was treated with platelet-rich plasma combined with artificial dermal stent (Pelnac, registration number: National Food and Drug Supervision Instrument (Jin) No. 364 1815 ) transplantation to cover the tendons and bones after debridement. Skeletal exposed wounds in the control group were treated with artificial dermal stent transplantation, fixed with (3-0) silk thread or skin nails, covered with a single Vaseline gauze, and dressed under pressure. After 2 weeks, autologous ultra-thin skin graft was performed, and dressing was changed regularly until the wound healed. Results The wound healing time of the observation group (11.50.58 days after operation) was shorter than that of the control group (13.250.58 days) (p < 0.05). One month after wound healing, Vancouver Scar Scale (VSS) in the observation group (5.330.33 points) was significantly lower than that in the control group (7.750.48 points) (p < 0.01), and the VSS score in the observation group (1.830.37 points) was significantly lower than that in the control group (4.580.29 points) (p < 0.01). The results were statistically significant. Conclusion Platelet-rich plasma combined with artificial dermis/autologous ultra-thin skin graft can promote wound healing, reduce pigmentation and scar formation, and improve the quality of wound healing.