真皮下血管网皮片修复手部创面和瘢痕畸形修复中的作用

目的 探讨真皮下血管网皮片在手部创面和瘢痕畸形修复中的作用。方法 对30例手部深Ⅱ～Ⅲ度烧伤创面和20例手部瘢痕畸形患者采取真皮下血管网皮片移植修复。结果 烧伤创面和瘢痕创面各1例出现水疱样改变，没有皮片死亡，术后皮片颜色和功能恢复良好。结论 真皮下血管网皮片在手部创面和瘢痕畸形修复中具有较好的效果。     

Meek微型皮片移植技术联合VSD治疗大面积深度烧伤的临床疗效

目的探究Meek微型皮片移植技术联合负压封闭引流术(VSD)治疗大面积深度烧伤患者的临床效果。方法选取2015年11月～2018年2月我院收治的大面积深度烧伤患者72例,依据随机数表法分为两组各36例。对照组行Meek微型皮片移植技术治疗,观察组行Meek微型皮片移植技术联合VSD技术治疗。统计对比两组皮片成活率、细菌培养阴性率、瘢痕情况、创面愈合时间及患者满意度。结果观察组皮片成活率为97.22%,细菌培养阴性率为100.00%,均分别高于对照组72.22%、83.33%,差异均有统计学意义(P<0.05);观察组瘢痕评分较对照组低,创面愈合时间较对照组短,差异均有统计学意义(P<0.05);观察组患者满意度为94.44%,高于对照组的72.22%,差异有统计学意义(P<0.05)。结论对大面积深度烧伤患者联合采用Meek微型皮片移植技术、VSD技术治疗,可有效提高皮片成活率及细菌培养阴性率,降低瘢痕评分,缩短创面愈合时间,提高患者满意度,在临床治疗中具有重要意义。     

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21～65 d.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.     

富血小板血浆治疗联合植皮在小面积骨外露创面中的临床应用

目的 观察富血小板血浆(PRP)治疗联合同期自体皮片移植修复外伤后小面积骨外露创面的临床效果。方法 选取60例骨外露创面患者作为研究对象,根据不同手术方式分为对照组(人工真皮联合皮片移植)和观察组(PRP联合皮片移植),每组30例。观察并比较2组患者植皮术后10 d皮片存活率、住院时间和手术费用;分别于植皮术后1、5 d采用视觉模拟评分法(VAS)评估2组患者疼痛程度,术后6个月随访时评估2组患者温哥华瘢痕量表(VSS)评分。结果 观察组住院时间短于对照组,手术费用低于对照组,差异有统计学意义(P<0.05)。术后1 d时,观察组VAS评分低于对照组,差异有统计学意义(P<0.05);术后5 d时,2组VAS评分比较,差异无统计学意义(P>0.05)。2组术后10 d时皮片存活率比较,差异无统计学意义(P>0.05)。术后6个月时,观察组VSS评分低于对照组,差异有统计学意义(P<0.05)。结论 PRP治疗联合同期自体皮片移植术对外伤后小面积骨外露创面有较好的临床疗效,可减轻术后疼痛和瘢痕形成,缩短患者住院时间,减少手术费用。     

手部烧伤后瘢痕挛缩畸形的整形治疗方法及临床预后情况分析

目的 观察对手部烧伤后瘢痕挛缩畸形患者予以整形治疗的效果。方法 选取2021年2月—2023年1月就诊于枣庄市皮肤病性病防治院的70例手部烧伤后瘢痕挛缩畸形患者为研究对象,按随机数表法分为对照组(35例,常规外科手术治疗)和研究组(35例,常规外科+整形治疗),对比两组的治疗效果、并发症、创面愈合时间、生活质量评分。结果 研究组治疗效果(94.29%)明显高于对照组(77.14%),并发症发生率(2.86%)低于对照组(22.86%),差异有统计学意义(χ²=4.200、4.590,P均<0.05);治疗后,研究组创面愈合时间明显短于对照组,日常生活活动能力评分、手部关节功能利用总主动活动度、生活质量评分高于对照组,差异有统计学意义(P均<0.05)。结论 对手部烧伤后瘢痕挛缩畸形患者予以整形治疗效果突出,可减少并发症,提高外观满意度,促进日常生活能力和手部关节功能恢复,利于生活质量改善。     

异体脱细胞真皮应用于手部深度烧伤创面治疗中的临床优势评价

目的:探究将异体脱细胞真皮应用于手部深度烧伤创面治疗中的临床效果。方法:本次研究所涵盖的对象为2019年4月至2020年7月本院收治的89例手部深度烧伤患者,依照摸球法将其分为观察组和对照组,观察组患者44例,对照组患者45例。对照组患者采用自体刃中厚皮片移植方式进行治疗,观察组患者采用异体脱细胞真皮支架与自体刃中厚皮片移植方式进行联合治疗,将两组患者的治疗效果以及手部功能指标进行对比,分析异体脱细胞真皮应用于手部深度烧伤创面治疗中的临床效果。结果:对比研究发现,观察组患者的治疗优良率显著高于对照组患者,且观察组患者的手部功能评分优于对照组患者,差异具有统计学意义(P<0.05)。结论:异体脱细胞真皮可以极大地增强手部深度烧伤患者的治疗效果,帮助患者改善手部功能,故而应当在该类患者的临床治疗实践中广泛采用异体脱细胞真皮治疗方式。     

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。     

负压封闭引流联合新鲜冰冻血浆灌注治疗糖尿病足溃疡的临床效果观察

目的探讨负压封闭引流(VSD)联合新鲜冰冻血浆灌注治疗糖尿病足溃疡的临床疗效。方法选取2017年5月至2019年1月我院接收的糖尿病足溃疡患者56例,随机等分为研究组和对照组,对照组行VSD治疗,研究组行新鲜冰冻血浆(FFP)灌注联合VSD治疗。比较两组疗效、创面愈合时间、创面床准备时间、移植皮片存活率、细菌清除率。结果研究组疗效高于对照组(P0.05),创面愈合时间、创面床准备时间均短于对照组(P0.05),移植皮存活率、细菌清除率均高于对照组(P0.05)。结论对糖尿病足溃疡患者应用FFP灌注联合VSD治疗能取得较好疗效,缩短创面愈合时间和创面床准备时间,提高移植片存活率和细菌清除率,值得临床推广应用。     

异体脱细胞真皮在手部深度烧伤创面治疗中的应用

目的探讨异体脱细胞真皮在手部深度烧伤创面治疗中的应用效果。方法选择某院烧伤整形科2015年1月至2018年9月收治的40例手部深度烧伤创面患者开展前瞻性研究,按照随机数表法分为两组,每组20例,对照组施行单纯自体中厚皮片移植治疗,观察组在对照组基础上采用异体脱细胞真皮移植,比较两组的临床疗效、创面组织病理学评分、疼痛评分、皮片成活率、外观平整度、手功能评分。结果临床总有效率观察组(95.00%)较对照组(70.00%)更高(P0.05)。治疗后,观察组的创面组织病理学评分、手功能评分均较对照组更高(P0.05),其疼痛评分较对照组更低(P0.05)。皮片成活率观察组较对照组更高(P0.05),外观平整度观察组较对照组更高(P0.05)。结论在手部深度烧伤创面治疗中应用异体脱细胞真皮移植,可提高临床疗效,确保皮片成活,改善手功能和外观。     

厚中厚皮游离移植治疗手部烧伤瘢痕畸形

厚中厚皮游离移植治疗手部烧伤瘢痕畸形解放军第一六三中心医院曾跃林，丁寿勇，傅祖国，张朝跃手部烧伤，特别是深度烧伤，在创面愈合后常发生瘢痕增生或／和瘢痕挛缩畸形。我科１９８６年以来，用厚中厚皮游离移植治疗手烧伤后严重瘢痕挛缩畸形２０例。经随访效果满意。...     

纳米银敷料结合重组牛碱性成纤维细胞生长因子凝胶治疗烧伤残余创面

目的:观测纳米银敷料结合重组牛碱性成纤维细胞生长因子凝胶治疗烧伤残余创面的疗效.方法:选取临床深II度及III度烧伤所致残余创面患者40例,随机分为两组,每组20例.治疗组应用纳米银敷料结合重组牛碱性成纤维细胞生长因子凝胶进行换药:对照组应用生理盐水和无菌石蜡油纱布换药.观测记录各组病例的愈合时间、创面感染例数、不同时相点创面愈合率、各组治疗前和治疗7 d时创面细菌培养情况、药物不良反应.结果:治疗组的愈合时间明显短于对照组(P<0.01);治疗组不同时相点创面愈合率明显高于对照组(P<0.01);治疗组创面感染例数明显少于对照组(P<0.01);治疗7 d后,治疗组致病细菌检出率明显低于对照组(P<0.01).结论:将纳米银敷料结合重组牛碱性成纤维细胞生长因子凝胶应用于可以非手术治疗的烧伤残余创面,有较好的抗菌作用及促进创面修复作用,能有效缩短烧伤残余创面的愈合时间.     

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     

烫伤消疤软膏对猪深Ⅱ度烧伤创面愈合影响的实验研究

目的观察烫伤消疤软膏对猪深Ⅱ度烧伤创面愈合影响。方法采用猪深Ⅱ度烧伤模型,创面外用烫伤消疤软膏,通过伤后不同时相点创面取材,检测烧伤创面羟脯氨酸（OHP）含量、创面细胞DNA含量和细胞周期变化、创面含水量、创面愈合率及组织病理形态学变化。结果创面外用烫伤消疤软膏后创面羟脯氨酸含量、创面细胞S期细胞百分比、创面愈合率均高于烧伤对照组,而创面含水量、创面细胞G     

自体微粒皮及脂肪混合移植治疗大关节深度烧伤的近远期疗效观察

目的观察自体微粒皮及脂肪混合移植治疗大关节深度烧伤的近远期疗效。方法大关节深度烧伤感染患者80例根据入院顺序随机分为两组,治疗组与对照组各40例,对照组采用传统植皮手术方法治疗,治疗组采用自体微粒皮及脂肪混合移植治疗。结果经过观察,术后30d、60d创面愈合率,治疗组较对照组明显增加（P〈0．01）。经过治疗后,两组的CD3＋、CD8＋含量水平都有明显增加,CD4＋含量水平有明显降低,但是治疗组的改善程度好于对照组（P〈0．05）。结论自体微粒皮及脂肪混合移植治疗大关节深度烧伤在近期能提高治疗创面愈合率,在远期能改善患者免疫状况,值得推广应用。     

Efficacy of moist exposed burn ointment on burns

In this study, we sought to test the medical efficacy of a Chinese medical herb product, moist exposed burn ointment (MEBO), on wound healing rate and infection control in burn injury. Standardized deep burn wounds were created on the back skin of rats by applying a hot brass bar for 12 to 18 seconds. MEBO was applied four times per day and compared with petroleum jelly, silver sulfadiazine, and dry exposure therapy. Under such a controlled setting, although MEBO had a better wound healing rate than the dry exposure treatment, it did not show the medical advantage statistically, as has been claimed, over the other two treatments (P > .05), either in terms of wound healing rate or bacterial control. We conclude that the MEBO is not suitable for deep burn wound treatment, particularly when infection is a concern.     

Reduced wound contraction after grafting of full-thickness burns with a collagen and chondroitin-6-sulfate (GAG) dermal skin substitute and coverage with biobrane

Full-thickness burns destroy both the epidermal and dermal tissues of the skin. This study evaluates a collagen and chondroitin-6-sulfate dermal skin substitute (graft) that was applied to excised full-thickness burns and covered with Biobrane. Experimental conditions included: (a) no burn, subcutaneous implantation of the graft; (b) burn, excision, graft, coverage with Biobrane and bandages; (c) burn, excision, no graft, coverage with Biobrane and bandages; (d) burn only. forty-one days post-surgery, subcutaneous implantation (N = 3) of the graft caused no detectable contraction or necrosis of the overlying skin, whereas all burn wounds contracted. Measurements of wounds (percentage of original wound size) showed statistically significant differences between the following treatments; (a) graft plus Biobrane (N = 10), 34%; (b) no graft plus Biobrane (N = 9), 25%; (c) untreated burns (N = 6), 16%. Semi-quantitative evaluation of time to healing indicated by spontaneous detachment of Biobrane from wounds showed that grafted, excised wounds healed in an average of 2.7 weeks, while ungrafted, excised wounds required an average of 4.3 weeks to heal. Histological appearance of healed wounds after grafting and coverage with Biobrane resembles undamaged skin without epidermal adnexal structures. Excision of full-thickness burn eschar, followed by grafting with a collagen and chondroitin-6-sulfate dermal skin substitute and coverage with Biobrane provides reduced wound contraction within a six-week period of observation compared to non-excised wounds. Both more rapid and more complete wound healing took place compared to excised wounds that were not grafted.     

Early repairing with full thickness skin graft and postoperational rehabilitation treatment of deep burn of hand

Background: To deep burn of hand,Some adopted natural healing,some adopted removal of eschar,thin and intermediate thickness skin flap repairing,But after healing,proliferation and contracture of scar of pigmentation,obvious dryness,no brightness,had elasticity often appeared that would reduce tolerance of abrade and impair function and appearnce of fingers.Objective: To investigate the clinical effect of full thickness skin graft after removal of eschar on deep burn of hand.Unit:169th Hospital of PLA.Subjects: 36 cases of deep burn of hand were investigated including 28 males,8 females,aged 2-46 years old among which were 24 cases of flame burn,6 cases of scald,3 cases of acid burn,2 cases of alkali burn with 8 cases at both hands,3 cases at both palm and dorsum of hand.Intervention:(1)After 6-8d,when edema disappeared,routine therapy was adopted to circular eschar,relief incision;One day before operation,wet packing with antibiotics and bandaging was adopted to achieve relative asepsis circummstance.(2) 0.5 before operatioin,surface of wound was brushed completely,hibitane soaking for 30 min complex iodine sterilizing operation region.(3)Eschar was removed under tourniquet.Necrosed tissue was deleted completely,avoiding injuring vessels (if longe quantity of bone substance was exposed,transferred to other method;After complet hemostasis,wet packing with saline containing antibiotics for 10 min.(4) Full thickness skinflap was reilled to keep apporiate tension.After suture subcutaneous stasis of blood was irrigated;Skin flap was pressed with bits of ganze and compression bandage.Finger and wrist were fixed with plaster support.(5) Antibiotics was used systemicly;Operation part was elevated and stitches were removed after 10d.Movement was started from 15-20d,and increased successively.Result:Wound surface of all cases healed within 25d,survival rate of skin flap was over 95%.After 0.5-1 year of follow-up,no obvious proliferation and spasm of scar and dysfunction were found,outward appearance of hand,elasticity,brightness and abrade tolerance approached normal level.Conclusion: Early full thickness skin graft could promote healing of wound surface in deep burn of hand and decrease incidence of dysfunction leaded by proliferation and spasm of scar.     

深度手烧伤患者植皮术后功能康复护理

通过对100例手深度烧伤(深Ⅱ-Ⅲ度)削切痂、植皮术病人术后2周实施加压疗法、浸浴疗法、局部按摩、药物治疗、功能锻炼及心理护理、创面护理，结果 100例131只手获得较满意效果。提出护理时尽量减少康复活动引起的疼痛，训练强度循序渐进，以病人耐受为度。     

持续性封闭式负压引流装置用于皮肤移植术的临床疗效

目的观察持续性封闭式负压引流装置(VAC)用于皮肤移植术的临床疗效,评判其价值。方法选择68例需要进行皮肤移植手术的患者进行VAC辅助治疗,采用随机数字表的方法将之分为治疗组(34例)与对照组(34例)。两组植皮后,对照组常规外用碘伏清洗、油纱包扎处理,治疗组使用VAC辅助治疗。10~14 d后,对比两组临床疗效。结果治疗组植皮后总成活率、上皮化程度、创面细菌抑制率均高于对照组,差异具有统计学意义(P0.05);住院时间及术后并发症发生率较对照组较低,差异具有统计学意义(P0.05)。结论 VAC可提高烧伤后残余创面植皮成活率,促进创面的愈合。     

Role of serum amyloid P in skin graft survival and wound healing in burned patients receiving skin grafts

BackgroundRecent studies in animal models suggest that serum amyloid P (SAP) can affect burn wound healing. However, the role of SAP in a clinical setting remains unknown.MethodsWe enrolled 88 patients with third degree burn wounds. All the patients were candidates for auto-skin graft procedure using stamp skin graft. The complete graft healing time and the number of survived grafts were recorded. Serum SAP levels were assessed 1 day before operation.ResultsThere was no significant difference in SAP level between controls and patients. There were no significant differences noted among the patients with different burn surface area. However, when the patients in each group were stratified by SAP levels, the mean complete healing time of grafted wound and the mean numbers of survived skin grafts were significantly different. Spearman's analyses showed that the serum SAP levels negatively correlated with the complete wound healing time and mean numbers of survived skin grafts. Logistic regression analysis showed that the serum SAP levels and mean numbers of survived skin grafts were potent independent factors contributing to wound healing.ConclusionsThe results of this study suggest that the serum SAP levels may be an easy detected predictor for the healing of burn wounds.