表皮移植术在烧伤后色素脱失性瘢痕中的应用

目的：观察表皮移植术在烧伤后色素脱失性瘢痕中的治疗效果。方法：将色素脱失性瘢痕表皮去除,保留瘢痕基底,再用电动取皮刀切取健康自体表皮移植,共治疗26例患者。结果：26例患者移植皮片完全成活,随访2个月～3年,色素缺失改善满意,无继发畸形和功能障碍。结论：表皮移植术是治疗烧伤后色素脱失性瘢痕的较理想方法。     

连续三次表皮移植和光疗快速治疗烧伤后色素脱失1例

目的：探索使用疱皮移植和光疗简便快速治疗烧伤后色素脱失的可行性。方法：选取大面积烧伤后色素脱失的患者,机械磨削除去白斑区表皮,使用表皮（疱皮）移植法,在患者腹部正常皮肤区域用负压加温吸疱的方法制造多个水疱,剪下疱皮,仔细贴附到磨去表皮的白斑移植区,妥善加压包扎。等待敷料脱落后1周左右开始用窄谱中波紫外线照射,促进色素恢复。如果效果好,则继续修补其他部位白斑。结果：1例患者45天内先后接受了3次疱皮移植治疗,术后2周可看到明显颜色恢复,用窄谱中波紫外线照射后4周左右,白斑移植区肤色已经接近正常皮肤,可达到痊愈水平。结论：表皮（疱皮）移植和窄谱中波紫外线光疗能治疗烧伤后色素脱失,颜色恢复快,有可重复性。     

微晶磨削治疗烧伤后色素脱失的疗效观察

目的探讨烧伤后色素脱失的较理想的治疗方法。方法利用微晶磨疤机，磨除色素脱失部位（白斑）的表皮，用2．5倍放大镜观察表皮至均匀出现点状出血为止，再利用电动取皮机切取超薄刃厚皮片，移植于磨削创面，用无菌干纱布包扎。结果本组共18例患者（22处白斑），治疗后随访6～20个月，22处白斑均重新着色，移植表皮与周围皮肤颜色相近，界限不明显，无皮片挛缩及白斑复发，获得满意效果。结论采用移植带黑色素细胞的自体表皮，间接实现黑色素细胞的移植，使白斑永久着色。是一种较理想的治疗烧伤后色素脱失的有效方法。     

烧伤后色素脱失的治疗研究

目的：探讨烧伤后色素脱失的理想治疗方法。方法：利用微晶磨疤机磨除色素脱失部位（白斑）的表皮，放大２．５倍观察至出现均匀点状出血为止，再利用电动取皮机取下超薄刃厚皮移植于磨削创面，共治疗８例患者，１０处白斑。结果：１０处白斑的重新着色。移植表皮与周围皮肤颜色配经良好。界限不明显，无皮片挛缩，随访３月～２０月，无白斑复发现象，有８处白斑术后获得极为满意效果。结论：通过带黑色素细胞的自体表皮移植从而单位     

无疤痕祛除面部色素痣及其他皮肤损害

目的:为了治疗和预防烧伤与创伤后色色素脱失与色素沉着采用皮肤磨削和表皮细胞移植及药物治疗.方法:采用病人治疗进行临床研究进行总结讨论.结果:通过临床治疗皮肤磨削和表皮细胞移植对烧伤和创伤后的色素脱失与色素沉着有良好的治疗效果.结论:皮肤磨削和表皮细胞移植治疗色素脱失与色素沉着值得推广应用.     

微晶磨削治疗烧伤后色素脱失的疗效观察

目的 探讨烧伤后色素脱失的较理想的治疗方法. 方法 利用微晶磨疤机,磨除色素脱失部位(白斑)的表皮,用2.5倍放大镜观察表皮至均匀出现点状出血为止,再利用电动取皮机切取超薄刃厚皮片,移植于磨削创面,用无菌干纱布包扎. 结果 本组共18例患者(22处白斑),治疗后随访6～20个月,22处白斑均重新着色,移植表皮与周围皮肤颜色相近,界限不明显,无皮片挛缩及白斑复发,获得满意效果. 结论 采用移植带黑色素细胞的自体表皮,间接实现黑色素细胞的移植,使白斑永久着色,是一种较理想的治疗烧伤后色素脱失的有效方法.     

磨削后刃厚皮片移植修复烧伤性色素脱失

目的：采用表皮磨削及自体刃厚皮片移植技术治疗烧伤后脱色素改变。方法：局麻下应用磨削方法将脱色素区表皮磨去，电动取皮刀切取大张自体刃厚皮片，皮片厚度0.1-0.2mm，仅含表皮层。将皮片平整的贴附在磨削创面上，无需缝合，以凡士林油纱布和无菌敷料包扎，术后1周供植皮区分别予以暴露和半暴露。结果：本组35例患者术后1周拆除供、植皮区敷料，移植表皮全部存活，经2月观察，移植皮片的色素较周围正常皮肤略有加深，无色素减退现象出现，供植皮区均无瘢痕增生。结论：磨削后移植大张自体刃厚皮片是治疗烧伤后脱色素改变的理想方法。     

表皮移植治疗外伤性色素脱失的疗效观察和护理体会

目的:观察表皮移植治疗创伤后色素脱失的疗效及总结护理要点。方法:我院门诊表皮移植治疗外伤性色素脱失的患者40例,按照随机原则分为治疗组和对照组各20例。每组使用皮肤磨削机磨掉外伤引起的色素脱失区瘢痕上皮,使用表皮移植仪获取自体表皮,将获得的表皮移植于瘢痕色素脱失区创面。总结围手术期护理要点,通过提高护理质量,进一步获得更好的疗效。治疗组表皮移植时创面使用生长因子,对照组使用生理盐水。结果:治疗组色素脱失治愈率为98%,高于对照组82%,差异具有统计学意义(P0.05)。结论:生长因子能够显著提高表皮移植治疗创伤后瘢痕性色素脱失的疗效,提升围手术期护理质量能够进一步稳定疗效。     

薄层削片法自体表皮移植治疗白癜风37例

目的：观察采用超脉冲CO2激光磨削皮损区后移植薄层削片法获得的自体表皮移植治疗白癜风的疗效。方法：37例患者采用超脉冲CO2激光磨削皮损区后移植薄层削片的自体表皮,观察表皮移植后的疗效。结果：37例患者移植皮片共132片,其中痊愈42片,占31．8％;有效88片,占66．4％;无效2片,占1．8％,总有效率为98．2％。结论：采用超脉冲CO2激光磨削皮损区后移植薄层削片法获得的自体表皮治疗白癜风较为简便有效。     

信息动态

由于烧伤等原因产生的瘢痕区域常常出现散在或成片色素脱失,色素脱失部位表现为白斑.面颈、手部等暴露部位的白斑严重影响患者容貌,皮肤白斑,外观与白癜风相似,目前还缺乏有针对性的特效方法,临床上常使用自体表皮移植术治疗[1].自体表皮移植治疗该疾病有较好的效果[2-3],但采用手术植皮打包固定方法存在皮片移位、压力性皮片缺血受损等,从而使手术效果受到影响.2010年3月～2013年12月,笔者对31例医用胶固定自体表皮移植治疗瘢痕色素脱失的患者,实施相应的护理干预,取得良好效果,现报道如下.     

Depigmentation with Q-switched Nd:YAG laser in universal vitiligo: a long-term follow-up study of 4 years

Q-switched (QS) lasers are used for depigmentation in universal vitiligo, but there is limited data on long-term results after laser treatment. This study was conducted to assess the safety and long-term follow-up results of QS Nd:YAG laser treatment in combination with need-based topical depigmentation therapy for universal vitiligo. A retrospective study was performed on patients with universal vitiligo who had received QS Nd:YAG laser treatment from 2010 to 2013. All patients were contacted and called for follow-up. Patients who reported were assessed clinically and information regarding adverse effects and relapse (repigmentation) in the follow-up period were obtained. Any need for topical depigmenting creams or other interventions and overall satisfaction to treatment were also documented. Records of 34 patients were retrieved, out of whom 28 cases reported for the follow-up visit. Duration of follow-up ranged from 2 to 5 years (mean, 2.78). No long-term adverse effects were reported and the majority of patients were highly satisfied with treatment. Satisfactory results with >90% clearance of pigment was reported by 89.3% (25/28) of patients, out of whom 72% (18/25) had retained the therapeutic effect with the use of sunscreens with/without intermittent topical depigmentation therapies. In seven cases, partial to complete relapse was observed. QS Nd:YAG laser is an effective tool for treating residual pigmentation in universal vitiligo, and the therapeutic effect can be maintained in most cases with regular sunscreen use and need-based topical therapies.     

Cutaneous Hyperpigmentation Following Venous Sclerotherapy Treated with Deferoxamine Mesylate

BACKGROUND: Cutaneous hyperpigmentation after venous sclerotherapy is an adverse sequelae of difficult management. OBJECTIVE: To evaluate the degree of depigmentation with the use of deferoxamine mesylate (DM) in patients with postsclerotherapy hyperpigmentation treated with polydocanol (POL) for telangiectasias and reticular veins (0.2-5 mm diameter) and varicose veins (5-8 mm diameter). METHODS: The experimental group of 36 female patients (mean age 37 years) was divided in two groups. Group I consisted of 30 patients who were treated with POL at 0.25-0.50% concentration for telangiectasias and reticular veins. Group II consisted of six patients with prolonged postsclerotherapy hyperpigmentation (more than 6 months after treatment) in varicose veins that had been treated with POL at 1.5% concentration each week. Groups I and II were injected with DM 500 mg subcutaneously once a week until 81-100% depigmentation was reached. In group I, DM was injected at the time of sclerotherapy. These groups were compared to their respective control groups with similar conditions but allowing spontaneous depigmentation without DM. Evaluation was undertaken clinically and photographically, and the number of days required to reach the desired depigmentation of 81-100% was determined. RESULTS: When DM was used, depigmentation of 81-100% was observed in group I at 27 days, and for group II in 46 days. In each control group, similar depigmentation was seen at 150 +/- 19 and 255 +/- 11 days, respectively. Comparing results, there was a reduction in the time to depigmentation of 82% for each group (P <.0001). CONCLUSION: The weekly subcutaneous administration of DM 500 mg reduces the time to depigmentation by 82% in patients with postsclerotherapy cutaneous hyperpigmentation treated for telangiectasias and reticular veins and prolonged postsclerotherapy hyperpigmentation in varicose veins. In this study we could not explain why such variability exists in the length of time to spontaneous depigmentation.     

Biochemical investigations after burning injury: complement system, protease-antiprotease balance and acute-phase reactants

Seventeen burned patients were investigated--Group I (n=10) with a mean burned area expressed as unit burn standard (UBS) of 69 +/- 24 and Group II (n = 7) with a mean UBS of 23 +/- 8. Blood samples were collected immediately after admission, 6-12 h after injury, during the morning and evening of day 1, and then daily for 2 weeks. This prospective study demonstrated complement activation in vivo in all burned patients, measured by C3d/C3 ratio index which was not related to the extent of the burned surface. A significant protease-antiprotease imbalance, correlated to the severity of burns, was found, leukocyte elastase was increased throughout the observation period, alpha 2-macroglobulin drastically decreased in severely burned patients, and alpha 1-proteinase inhibitor promptly decreased below the normal level in patients with more than 40 UBS. Finally, there was a delayed but then persistent acute-phase reactant protein response involving C-reactive protein, haptoglobin and alpha 1-acid glycoprotein, the concentrations of which reached a plateau on days 6 or 7.     

Anaphylatoxin formation in plasma and burn bullae fluid in the thermally injured patient

Plasma anaphylatoxins (C3a and C5a) were measured in 19 thermally injured patients with a mean total burned surface area of 39 per cent (range 10-90 per cent) of partial and full skin thickness loss. Extensive burns were associated with increased anaphylatoxin activity. Patients with greater than 50 per cent burned surface area had higher plasma C3a and C5a concentrations than patients with 10-25 per cent burns (P less than 0.001) 1 week after injury. Six out of seven patients with greater than 50 per cent burned surface area developed adult respiratory distress syndrome (ARDS) and four out of seven bacteraemia. Twelve patients had 10-25 per cent burns and none of them developed ARDS or bacteraemia. The mean C3a concentration per millilitre of fluid from the burn bullae from nine different individuals was 2570 +/- 260 ng/ml. The C5a content in fluid from the bullae did not differ from the corresponding plasma range. Increased anaphylatoxin activity might explain extensive extravasation of fluid in burned patients. This increase might also be one reason for leukocyte accumulation in burned areas.     

重及特重度烧伤早期血胃泌素、胃动素和β内啡肽的测定及其意义

目的探讨重度及特重度烧伤后早期血清胃泌素、β内啡肽及血浆胃动素浓度的动态变化并分析其意义。方法以重及特重度烧伤住院患者32例为对象,分时段采血,放免检测血清胃泌素、β内啡肽和血浆胃动素浓度。结果重度及特重度烧伤后早期胃泌素明显降低,伤后8h一直在最低水平,但在9～24h段有一个高峰,后微下降至一相对稳定水平;胃动素在伤后2h为最高值,后在休克期内一直为低值,在伤后8h为最低,进入回吸期稳定上升,但仍低于正常;β内啡肽在伤后早期即升高,伤后8h最高。烧伤面积越大,胃泌素、胃动素降低越明显,β内啡肽升高越显著;但在超过70％面积时即没有相对应关系。结论重度及特重度烧伤后早期血清胃泌素、β内啡肽及血浆胃动素浓度的动态变化有一定规律性,疼痛应激,休克对其有明显影响。     

Reliability of island flaps raised after superficial and deep burn injury

In select cases, to prevent any functional loss and to initiate early function during the early burn period, the reconstructive procedure of choice may be flap coverage. In these circumstances, when the ideal flap donor site is burned, the clinician may be hesitant to raise this flap because of questionable flap survival. The authors conducted this study to determine whether a superficially or deeply burned skin island flap would survive when elevated during the early postburn period. If these flaps are usable, they could expand the options available for burn wound coverage. They used a rat epigastric island flap model, and divided 50 study animals into two groups. In group 1 (N = 25), the right epigastric flap site was burned superficially and the left side was left uninjured. Island flaps were raised on both sides 4 days after the burn injury. The flaps were then sutured back into their original sites, and were evaluated 5 days after the surgery. In group 2 (N = 25), the right epigastric flap site was burned deeply and the left side was left uninjured. Island flaps were raised 4 days after the burn injury on both sides, as in group 1. The flaps were then sutured back into place and were evaluated 5 days after the surgery. All of the control flaps on the rats' left sides survived in both groups. In addition, all the superficially burned flaps survived in group 1 (100%), and 21 of the deeply burned flaps survived in group 2 (84%). There was no significant difference between superficially and deeply burned flaps with regard to survival, and the burned flaps were as successful as the unburned control flaps in both groups (p = 0.11). Skin island flaps elevated after superficial or deep burn injury are reliable in this animal model.     

Use of the Q-Switched 755-nm Alexandrite Laser to Treat Recalcitrant Pigment after Depigmentation Therapy for Vitiligo

BACKGROUND: In patients with extensive vitiligo, depigmentation therapy is often preferred over attempts to restore skin color. Bleaching creams sometimes fail to permanently depigment the skin, leaving disfiguring pigmented patches. This recalcitrant pigmentation may be treated with Q-switched laser technology. OBJECTIVE: The objective was use the Q-switched alexandrite laser to treat recalcitrant pigmentation after unsuccessful attempts at total-body depigmentation for vitiligo. METHODS: We have attempted to destroy the remaining melanin pigmentation in a 68-year-old woman with vitiligo by using selective photothermolysis from a Q-switched alexandrite laser. RESULTS: Excellent results were achieved after 10 treatment sessions, with no recurrence of pigment after 1 year of follow-up. CONCLUSION: The Q-switched alexandrite laser was used successfully and safely in a vitiligo patient with recalcitrant pigmentation after unsuccessful depigmentation therapy and may prove useful in other such cases.     

插入式腹部薄皮瓣修复手和腕部严重烧伤

目的　探讨插入式腹部薄皮瓣修复手和腕部广泛深度烧伤的可行性 ,积累临床治疗经验。　方法　 12例手严重烧伤患者 ,均伴有多指背及手腕的创面。供瓣区选上腹部 4例 ,下腹部 8例。皮瓣断蒂时间为 10～ 13d。　结果　除 2例皮瓣远端有 2cm× 2cm及 1cm× 1cm大小坏死外 ,其余均全部成活。患者手功能及外形恢复满意。　结论　腹部真皮下血管网皮瓣修复手和腕部严重烧伤是一种比较好的手术方法。     

非剥脱性Q开关Nd:YAG 1 064 nm激光对黄褐斑的治疗效果

目的 观察非剥脱性Q开关Nd:YAG 1 064 nm激光对黄褐斑的治疗效果.方法 应用Q开关Nd:YAG 1 064 nm激光对23例黄褐斑患者进行治疗,其光斑直径6 mm,脉宽5～7 ns,频率10 Hz,能量密度1.8～2.0 J/cm2.一般需8～10次治疗,每次治疗间隔1周.结果 23例经8～10次治疗后,黄褐斑明显淡化或消失,局部出现轻度充血,无水泡和结痂形成,基本治愈率达52.17%.5例出现眼睑紫癜,3 d后自行消退,无色素沉着及瘢痕发生.术后随访6个月以上,其中7例(占30.4%)出现复发,继续治疗仍然有效.结论 非剥脱性Q开关Nd:YAG 1 064 nm激光治疗黄褐斑虽有复发,仍不失为一种比较可行的治疗方法 ,有一定效果,操作简单、安全,不影响患者的工作和生活.