脱细胞猪皮为覆盖物的微粒皮移植修复大面积深度烧伤创面

背景：目前用作微粒皮的覆盖物除异体皮外包括猪皮、羊皮、自体焦痂、凡士林油纱布等,由于猪皮皮肤结构与人体相近似,价廉易得,是目前使用较为广泛的微粒皮覆盖物。目的：观察脱细胞猪皮为覆盖物的微粒皮移植术运用于大面积深度烧伤治疗中的临床效果。方法：对15例大面积深度烧伤患者采用早期切（削）痂术或肉芽创面清创后,行自体微粒皮移植、以脱细胞猪皮为覆盖物,移植后观察覆盖物脱落以及创面修复情况进行回顾性分析。结果与结论：术后脱细胞猪皮与创面粘贴良好,术后5～7d首次换药见脱细胞猪皮呈黄褐色或紫黑色,脱水干燥,猪皮下偶有少量积液,开窗引流后猪皮未溶解脱落;三至四周脱细胞猪皮干燥坏死、与创面逐步分离,猪皮脱落后创面完全愈合,鲜有创面裸露,创面愈合后瘢痕较轻,外观及弹性可。提示,脱细胞猪皮可替代大张异体皮成为微粒皮移植术的理想覆盖物,可使大面积深度烧伤创面修复达到较为理想的效果。     

交联型猪脱细胞真皮基质与自体微粒皮复合移植的临床应用

目的:观察交联型异种(猪)脱细胞真皮基质与自体微粒皮复合移植修复大面积深度烧伤早期切痂创面的疗效。方法:选择2001-09/2006-10在珠海市人民医院暨南大学医学院第三附属医院整形烧伤科就诊的中面积和大面积深度烧伤患者16例共48个观测创面,患者均知情同意。患者于伤后3～5d休克期平稳渡过后行肢体创面切痂术,自体微粒皮移植组观测24个创面,均位于复合皮移植组创面的邻近或对侧肢体相同部位。①复合皮移植组:切痂创面用交联型异种(猪)脱细胞真皮基质(由江苏启东医疗用品研究所提供) 自体微粒皮复合移植 异体皮覆盖。②自体微粒皮移植组:切痂创面用自体微粒皮移植 异体皮覆盖。术后6周异体皮脱落,两组散在肉芽创面行小邮票状皮片补充移植修复创面。术后定期观察创面愈合情况,计算创面愈合率及收缩率,并行创面组织学检测。结果:两组48个创面均进入结果分析,无脱落。①两组异体皮成活情况相近。②术后6周,复合皮移植组患者的创面愈合率均显著低于自体微粒皮移植组(P<0.05);经补充植皮后即术后8周两组创面愈合率差异无显著性意义(P>0.05)。③移植术后6,8,12周,复合皮移植组患者的移植创面收缩率均显著低于自体微粒皮移植组[(10.28±2.36)%,(16.25±3.78)%;(15.68±1.79)%,(30.42±3.65)%;(22.07±1.39)%,(42.83±2.74)%(P<0.05)]。④术后8周组织学观察结果显示,复合皮移植组创面愈合处上皮化良好,胶原纤维排列有序,基底膜结构完整;自体微粒皮移植组上皮层仍较薄,细胞分化不良,真皮内胶原排列较紊乱。结论:交联型异种(猪)脱细胞真皮基质与自体微粒皮复合移植修复大面积深度烧伤早期切痂创面,能够抑制瘢痕增生,改善创面愈合质量,疗效满意。     

新鲜条状猪皮覆盖自体微粒皮治疗大面积深度烧伤的临床观察

大面积深度烧伤后早期切(削)痂植皮、尽早修复创面是整个救治过程中的重要环节。自体皮源不足是大面积深度烧伤创面修复所面临的关键性难题,由于微粒皮移植技术的运用大大节省了自体皮源,而成为大面积深度烧伤创面修复的有效方法之一。但经典的微粒皮移植术需以大张的同种异体皮肤为覆盖物,因异体皮来源困难且价格昂贵使该法广泛运用受到限制,尤其在基层医疗单位开展困难,2 0 0 0 - 0 9～2 0 0 3- 0 9间,笔者采用喷洒法皮粒播植术[1] ,并以自制新鲜条状猪皮作为创面覆盖物治疗大面积深度烧伤患者8例,取得良好效果,报道如下。1　资料与方法1 …     

微粒皮移植治疗大面积烧伤创面的护理

大面积烧伤后往往自体皮不足,造成创面感染难以控制及创面持续过度丢失,导致患者病情恶化及创面愈合效果差,自体微粒皮与异体（种）皮混合移植是目前大面积深度烧伤创面有效覆盖的主要手段。本科2008年2月-2009年3月采用微粒皮移植辐照猪皮覆盖术治疗大面积烧伤患者15例,取得良好效果,现将护理体会报告如下。     

分批次微粒皮移植治疗大面积深度烧伤患者临床效果观察

目的观察大面积烧伤患者采用一期四肢切削痂自体微粒皮移植术与分次切削痂自体微粒皮移植术两种手术方法的临床效果。方法大面积烧伤患者12例作为观察组,手术分2次进行,首次优选2个肢体,创面切削痂后自体微粒皮移植加脱细胞异种真皮基质覆盖,7¹2 d后剩余2个肢体再行相同手术方法治疗;大面积烧伤患者13例作为对照组,四肢行切削痂自体微粒皮移植加脱细胞异种真皮基质覆盖一期完成。对比观察两组病例一般情况、手术时间、手术人数、术中切削痂面积、术中输液总量、输注浓缩红细胞数量、30 d皮肤愈合率、痊愈时间、创面脓毒症、死亡率、住院费用。结果两组一般情况及总手术植皮面积、手术人数,差异无统计学意义。观察组每次手术时间、术中输液量、RBC用量较对照组有统计学差异(P<0.05),术后30 d皮肤愈合率提高,痊愈时间、创面脓毒症、死亡率、住院费用较对照组有统计学差异(P<0.05),单次手术时间缩短1.135 h,平均手术次数减少0.5次。结论大面积烧伤患者行四肢分次切削痂自体微粒移植加异种皮移植治疗,可明显减轻对患者的二次打击,同时保证了自体微粒皮移植密度,从而促进了创面愈合,减少术后并发症发生率,提高了此类患者的救治成功率。     

自体微粒皮移植术在大面积深度烧伤并发症防治中的作用

目的 探讨自体微粒皮移植术在大面积深度烧伤并发症防治中的作用。方法 比较性研究我院1993-2002收治的大面积深度烧伤患者64例,根据早期创面处理方法的不同分为切痂自体微粒皮移植术组和切痂邮票状植皮术组,两组患者的一般情况具有可比性。自体微粒皮移植术组行一次性大面积切痂自体微粒皮和大张异体皮联合移植术,切痂邮票状植皮术组分次行部分Ⅲ度创面切痂自体邮票状皮片移植术。观察自体微粒皮移植术后的临床过程,并比较两组患者脓毒症和MODS的发生率。结果①5-7 d,异体皮表皮层出现疱状变性;2周左右,异体真皮出现黑色斑点;4-6周,形成痂皮脱落,其下为新生表皮覆盖。②自体微粒皮移植术组脓毒症和MODS的发生率分别为34.4％和18.8％,明显低于切痂邮票状植皮术组的62.5％和43.8％,差异有显著性(P<0.05)。结论 自体微粒皮移植术治疗大面积深度烧伤切实可行、疗效确切,能有效降低MODS的发生率。     

18例重度烧伤自体焦痂作覆盖物加自体微粒皮移植患者手术前后的护理

总结18例重度烧伤患者自体焦痂作覆盖物加微粒皮移植手术前后的护理。护理要点包括:重度烧伤患者于伤后3~7 d内切痂,行焦痂原位回植加自体微粒皮移植术,通过术前抗休克、保痂,术后制动,早期采用暴露疗法防止创面渗血影响微粒存活,避免创面受压,观察术后焦痂原位回植加自体微粒皮移植效果。18例焦痂原位回植加自体微粒皮移植术患者术后6周的创面愈合率为(85.4±3.9)%,创面愈合时间为伤后(55.6±7.1)d。证明通过对焦痂原位回植加自体微粒皮移植术的护理,可提高该术式的成功率,用自体焦痂替代异体皮覆盖移植的方法可行,并具有较好的临床应用价值。     

自体微粒皮移植结合重组人生长激素治疗大面积深度烧伤探讨

目的探讨大面积深度烧伤非功能部位应用白体微粒皮复合移植，术后应用重组人生长激素（rhGH）治疗的优势。方法以异体皮为载体，将自体刃厚皮片制作成微粒皮后均匀地移植于创面，术后结合rhGH治疗，观察烧伤非功能部位创面愈合时间和创面修复质量。结果14例患者创面平均愈合时间为（23．0±5．2）d，其中8例随访2年，移植区皮肤较平整、颜色呈灰褐或淡红色，质软、收缩少。结论大面积深度烧伤非功能部位应用自体微粒皮移植异体皮覆盖结合术后rhGH治疗是一种较理想的治疗方法。     

异种(猪)脱细胞真皮与自体微粒皮复合移植的疗效观察

目的用异种(猪)脱细胞真皮与自体微粒复合移植解决烧伤患者自体微粒皮移植术后功能欠佳的问题。方法5例男性,TBSA50％～95％,Ⅲ度30％～70％,异种脱细胞真皮移植100～150cm2,采用两步法,外层覆盖异体皮。结果术后4～6周异体皮脱落,创面愈合80％左右,复合皮移植处外观平整,皮肤弹性及关节功能较对照部位好。半年后复诊关节功能正常,疤痕增生不明显。结论异种(猪)脱细胞真皮来源容易、价格低廉,与自体微粒皮复合移植,疗效满意。     

应用异体甘油保存皮与自体微粒皮复合移植治疗大面积深度烧伤

目的 寻找深度大面积烧伤的早期治疗方法。方法 大面积深度烧伤于4～5天即行切痂，以异体甘油皮为支架，将有限的自体皮制作成微粒皮后均匀地复合植于创面。结果 对8例共14个肢体2个躯干进行早期切痂后异体甘油皮＋自体微粒皮的复合移植，成活后的创面平坦、外观平整、颜色淡红或近似正常皮肤，触软、收缩少。结论 异体甘油保存皮＋自体微粒皮复合移植是大面积深度烧伤较理想的治疗方法。     

电动磨痂治疗深Ⅱ度烧伤创面的疗效观察

目的：分析比较削痂和电动磨痂在治疗深Ⅱ度烧伤创面的应用。方法：93例深Ⅱ度烧伤住院患者随机分成两组，一组进行削痂手术，另一组行磨痂手术，观察比较两组患者手术治疗效果。结果：与削痂组创面比较，磨痂组创面愈合时间提前5～6d，且愈合质量好，瘢痕增生轻。从病理上看，磨痂手术能最大限度地保留有活力的组织和皮肤附件。结论：用电动磨痂仪施行的磨痂手术操作简单，易于掌握；对组织损伤小，能充分地保留有活力的真皮组织及皮肤附件；创面再上皮化迅速，缩短愈合时间，减轻病人的负担；创面愈合质量好，瘢痕形成轻或无瘢痕。     

A silver-sulfadiazine-impregnated synthetic wound dressing composed of poly-L-leucine spongy matrix: an evaluation of clinical cases.

The management of severe burns requires the suppression of bacterial growth, particularly when eschar and damaged tissue are present. For such cases, silver sulfadiazine (AgSD) cream has been traditionally applied. This antibacterial cream, however, cannot be used in conjunction with a temporary wound dressing that is needed to promote healing. The authors developed a synthetic wound dressing with drug delivery capability for clinical use by impregnating a poly-L-leucine spongy matrix with AgSD, which is released in a controlled, sustained fashion. In general, the dressing adhered firmly to the wound in the case of superficial second-degree burns, and during the healing process it separated spontaneously from the re-epithelialized surface. In the management of deep second-degree burns where eschar and damaged tissue were present, the dressing had to be changed at intervals of 3 to 5 days until it adhered firmly to the wound. Once the dressing had firmly attached to the wound, it was left in place until it separated spontaneously from the re-epithelialized surface. Dressing changes were fewer than with other treatments and the pain was effectively reduced. Cleansed wounds were effectively protected from bacterial contamination. Of 52 cases treated with this wound dressing, 93% (14/15) of superficial second-degree burns, 75% (3/4) of deep second-degree burns, 85% (6/7) of superficial and deep second-degree burns, and 75% (12/16) of split-thickness skin donor sites were evaluated as achieving good or excellent results.     

深度手烧伤的治疗及功能康复

目的 :探讨深度手烧伤早期创面修复及功能康复最好的治疗方法。方法 :应用中厚皮、异体去细胞真皮基质作支架加自体刃厚皮片移植 ,腹部真皮血管网皮片及超薄皮瓣移植等手术方式 ,进行深度手烧伤早期切削痂。结果 :2 94例 4 6 2只手功能良好者 138例 2 32只手 (5 0 % ) ,功能较好者 79例 134只手 (2 9% ) ,功能障碍者 77例 96只手 (2 1% )。结论 :应用早期切削痂植皮的方法可减少瘢痕增生和畸形 ,使深度手烧伤后获得满意的外形和功能     

Meek微型皮片移植修复大面积深度烧伤

背景：Meek植皮法是近5年来引进并陆续在国内多家医院采用的一项创面修复的新技术。目的：观察Meek微型皮片移植修复在大面积深度烧伤患者皮肤缺损的效果。方法：对16例大面积深度烧伤创面患者,采用早期切（削）痂后及晚期肉芽创面Meek植皮法植皮,其中6例选取Ⅲ度烧伤面积30%左右患者同一个体行相同面积Meek微型皮片植皮法,和自体小邮票植皮作为对照。结果与结论：采用Meek微型皮片植皮法皮片成活率65%～95%,创面愈合时间21～65d。Meek微型皮片与自体邮票植皮相比缩短了手术时间,节省了皮源,创面愈合后瘢痕平整,挛缩率低,关节功能恢复良好。     

新鲜异体皮在大面积深度烧伤治疗中的应用

目的：探讨大面积深度烧伤切削痂植皮的方法，进一步提高手术疗效。方法：2002年8月～11月对7例大面积深度烧伤患者实行早期切削痂新鲜异体皮覆盖手术，并在术后分期自体植皮。结果：7例中2例在治疗过程中死亡，5例经8～14次自体植皮创面完全愈合。结论：新鲜异体皮能与创面建立良好血管形成，是目前切削痂后最好的创面覆盖物。     

Application of split-thickness dermal grafts in deep partial- and full-thickness burns: a new source of auto-skin grafting

Early tangential excision of nonviable burn tissue, followed by immediate skin grafting with autograft or allograft, has resulted in the improvement of burn patient survival. The aim of this study was to add split-thickness dermal grafts (STDGs) as a new source of auto-skin grafting tool to our reconstructive armamentarium in deep partial- and full-thickness burns and soft tissue defects. The authors successfully applied STDGs along with split-thickness skin grafts as a new source of auto-skin grafting in 11 deep partial- and full-thickness burns over a period of 1 year without any significant donor site morbidity. Dermal graft take was complete in all but one patient. There was no donor site healing problem, and donor site epithelization was completed generally 1 week later than split-thickness skin graft by semi-open technique. Autologous split-thickness skin grafting still remains the standard therapy for burn wound closure but may be in limited availability in severe burns. The authors conclude that STDGs may be a new source of auto-skin grafting tool in extensive deep partial- and full-thickness burns.     

Topical chemotherapy for the treatment of burns

A burn is a tissue lesion which provokes different alterations that vary from topical erythema to total destruction of the structures affected. A burn always produces an alteration in the skin, a lesion in the corneal strata is sufficient to cause the skin to lose its capacity to act as a barrier. The objective the treatment for a burn has is to produce epithelization as soon as possible in order to prevent infection and to reduce functional and esthetic aftereffects. Infection is the main cause of death due to burns due to the growth of endogenous flora or due to external contamination. The use of topical chemotherapy is fundamental to prevent infections when there are deep and superficial burns or extensive intermediary burns. Centella asiatica extract has proven to be efficient in helping, maintaining and regularizing cicatrisation of skin affected by burns. Its usage combined with an antibiotic agent such as neomycin covers the bacterial spectrum for gram-positive or -negative microorganisms, guaranteeing an anti-infectious efficiency for this extract.     

Recombinant human collagen III gel for transplantation of autologous skin cells in porcine full‐thickness wounds

Complex skin wounds, such as chronic ulcers and deep burns, require lengthy treatments and cause extensive burdens on healthcare and the economy. Use of biomaterials and cell transplantation may improve traditional treatments and promote the healing of difficult‐to‐treat wounds. In this study, we investigated the use of recombinant human collagen III (rhCol‐III) gel as a delivery vehicle for cultured autologous skin cells (keratinocytes only or keratinocyte–fibroblast mixtures). We examined its effect on the healing of full‐thickness wounds in a porcine wound‐healing model. Two Landrace pigs were used for the study. Fourteen deep dermal wounds were created on the back of each pig with an 8 mm biopsy punch. Syringes containing acellular rhCol‐III gel (n = 8) or rhCol‐III gel with autologous keratinocytes (n = 8) or rhCol‐III gel with autologous keratinocytes and fibroblasts (n = 8) were applied into wounds. Untreated wounds were used as controls for the treatment groups (n = 4). We used rhCol‐III gel to manufacture a cell‐delivery syringe containing autologous skin cells. In a full‐thickness wound‐healing model, we observed that rhCol‐III gel enhances early granulation tissue formation. Interestingly, we found cell type‐dependent differences in the stability of rhCol‐III in vivo. Fibroblast‐containing gel was effectively removed from the wound, whereas gels without cells or with keratinocytes only remained intact. Our results demonstrate that the properties of rhCol‐III gel for skin cell transplantation can be significantly altered in a cell type‐dependent manner. Copyright © 2013 John Wiley & Sons, Ltd.