全颜面整张全厚皮片移植治疗面部瘢痕畸形20年观察

目的　评价全颜面整张全厚皮片移植修复面部瘢痕畸形的远期效果。方法　对 18例全颜面部烧伤后瘢痕畸形患者行全颜面整张全厚植皮术 ,术后随访 5～ 2 0年 ,观察植皮后面部皮肤色泽、弹性、感觉及腺体分泌情况 ,并选择典型病例切取标本行光学显微镜及电子显微镜观察。结果　受术者远期效果好 ,颜面植皮区皮肤光洁红润 ,弹性好 ,有皮脂腺、汗腺分泌 ,其组织学结构、超微结构具备正常面部皮肤的特征 ,与原供皮区结构不一致。结论　1 全颜面整张全厚植皮术远期效果良好 ,是治疗面部瘢痕畸形的理想方法。 2 全颜面全厚皮片移植后远期将具备受皮区的皮肤结构特点。     

全面部深度烧伤及瘢痕畸形的整复

１９７９年以来，作者共治疗３７例全颜面部浓度烧伤及烧伤后瘢痕挛缩畸形。其中施行整张全厚皮移植整复３例，整张带真皮下血管网的全厚皮移植１例，改良的全厚皮移植２６例，大张中厚皮片分区移植修复７例，术后３－１５年的随访观察显示整张全厚皮移植者，面部皮肤光洁红润，表情自然；大张中厚皮片分区移植者，皮片拼接外有瘢痕，皮肤弹性差，有色素沉着。改良的整张全厚皮移植，较好地解决了眼睑及下唇继发挛缩外翻问题，是一值     

整张全厚皮片移植治疗全指背手背腕背增生性瘢痕

目的：探讨应用整张全厚皮片移植一次修复全指背手背腕背增生性瘢痕的可行性及方法。方法：自2005年6月～2009年6月,对10例患者,14只手的全指背、手背、腕背增生性瘢痕合并轻、中度瘢痕挛缩畸形进行切除和松解,应用整张全厚皮片一次植皮整复,同时视瘢痕大小和供皮区的情况,联合侧胸部皮肤扩张术供皮。结果：10例患者,14只手背瘢痕松解植皮,植皮全部成活,手部功能恢复良好。结论：应用整张全厚皮片一次移植治疗全指背手背腕背增生性瘢痕效果理想。     

负压封闭引流技术（VSD）联合游离全厚植皮术治疗四肢皮肤缺损的临床效果

目的探讨负压封闭引流技术（VSD）联合游离全厚植皮术治疗四肢皮肤缺损的临床效果。方法选取笔者所在医院收治的严重四肢大面积皮肤缺损患者20例,采用VSD治疗7天,然后采用游离全厚植皮＋VSD治疗后观察疗效。结果 19例游离全厚植皮全部成活,1例部分坏死。结论 VSD结合游离全厚植皮术是治疗严重四肢大面积皮肤撕脱伤较好的处理方法,这种方法值得在临床上推广。     

延期皮肤移植术在烧伤后重度关节畸形整复中的应用

目的 探索治疗重度瘢痕挛缩性关节畸形简便有效的整复技术。方法 Ⅰ期手术整复关节畸形。创面延期3-5天。Ⅱ期手术植大片中厚皮，观察皮片成活质量及远期整复效果。结果 延期植皮法皮片成活率达100%，关节畸形经分期整复可达到完全复位，远期整复效果良好。结论 延期植皮技术是一种简单有效的重度关节畸形整复方法。     

封闭式负压引流联合植皮术治疗截肢术后残端皮肤坏死

目的:观察封闭式负压引流联合植皮术在治疗截肢术后残端皮肤坏死的临床效果。方法:将48例截肢术后残端皮肤坏死的患者分成两组,治疗组25例采用封闭式负压引流技术联合植皮法治疗,对照组23例采用传统打包加压植皮法治疗,7～10d后观察两组植皮成活情况。结果:治疗组植皮成活率、植皮平均愈合时间、感染率、皮片色泽及外观平整度明显优于对照组。结论:应用封闭式负压引流联合植皮术治疗截肢术后残端皮肤坏死,具有植皮成活率高、植皮平整外观好,成活皮片瘢痕组织少、耐摩擦性好及有利于截肢佩戴等优势。     

利用皮片移植及皮瓣转移修复会阴部烧伤后瘢痕挛缩畸形

目的:探讨修复烧伤后会阴部瘢痕挛缩畸形的手术方法。方法:对1990年以来收治的38例会阴部烧伤后瘢痕挛缩畸形患者行瘢痕切除松解,21例患者单纯中厚或全厚植皮,4例患者单纯局部皮瓣转移修复,13例患者皮瓣转移配合植皮修复。结果:1例皮瓣尖端2cm坏死,2例部分皮瓣色暗紫,2例植皮部分成活欠佳,经换药及对症处理痊愈,余均疗效满意。结论:皮片移植及皮瓣转移为治疗会阴部瘢痕挛缩畸形的较好手术方法。     

五瓣成形结合游离植皮术治疗腋窝蹼状瘢痕挛缩畸形

目的：应用五瓣成形,配合游离植皮术治疗腋窝蹼状瘢痕挛缩畸形.方法：根据五瓣成形术原理将蹼状瘢痕切开形成五个组织瓣,使其中三瓣位于正常皮肤较多一侧,在充分松解深层挛缩组织后,相互调换皮瓣位置,延长瘢痕纵轴长度,修复腋部创面;尚有的创面游离植皮修复.结果：20例术后皮瓣、皮片均成活良好,腋部形态好.结论：五瓣成形配合游离植皮术治疗腋窝蹼状瘢痕挛缩是一种操作简单、疗效确切的手术方法.     

植皮后不同康复疗法治疗效果比较

目的：探讨以康复处理加强面、手术烧伤瘢痕切除后游离植皮的手术效果。方法：皮片成活后对植皮部位采用用中草药离喷雾、瘢痕霜涂布按摩、中草药面膜等处理，10次为一疗程。结果：34例患者经3个疗程康复处理后，植皮区色泽及弹性均向接近正常皮肤方面转变。结论：康复护理可作为加强植皮效果的一种重要手段。     

阴茎延长术后皮肤坏死的临床处理(附12例报告)

目的:分析阴茎延长术后皮肤坏死原因及相应的处理措施,观察游离皮片植皮治疗阴茎皮肤缺损的临床效果。方法:回顾性分析我科自2017年1月至2022年1月收治的12例阴茎延长术后阴茎皮肤大面积坏死缺损的病例资料。12例患者经过多种方式创面准备后行大腿中厚或全厚游离皮片植皮修复术。结果:12例患者植皮成活良好,切口均一期愈合,未发生二次感染坏死等并发症。术后随访6个月,阴茎植皮区域皮肤感觉大部分恢复,皮肤无明显破溃,水肿,阴茎外观满意。行IIEF-5、EHS量表评分及阴茎硬度检测结果反应勃起功能情况,均提示勃起功能正常。结论:阴茎皮肤大面积坏死行自体中厚或全厚游离皮片植皮修复术临床疗效满意,可有效解决阴茎延长术后出现皮肤大面积坏死的严重并发症难题。     

Total full-thickness skin grafting for treating patients with extensive facial burn injury: A 10-year experience

IntroductionFacial burns are not only a severe burn injury, but result in psychological disturbance. The improvement of the methods of treating facial burns remains topical. The aim of the study was to evaluate the effectiveness of approach based on full-thickness skin autografting for facial burn injuries.MethodsDuring 2000–2019, ninety seven patients with the facial burn were treated in Burn Center. All patient were divided into two groups. The comparative analysis between groups was done.ResultsGroup A was treated with full-thickness skin grafts (42 patients – 43.3%). Since 2010, total full-thickness skin graft was used in 11 patients from Group A. In group B, 55 patients (56.7%) were treated with split-thickness skin grafts, including 9 patients (16.4%) with total split-thickness skin graft transplantation. Total full-thickness skin graft was performed in case of a deep and extensive facial burn and cicatricial deformities. During the long-term period, a positive cosmetic result and the absence of indications for reconstructive operations were noted.ConclusionThe approach of facial burn treatment based on total full-thickness skin graft allows conditions for engraftment and adaptation of autograft, reduces the risk of scar developing and achieves maximum cosmetic results of treatment.     

大鼠深Ⅱ度烧伤创面保留变性真皮并覆盖自体皮疗效观察

目的为探讨自体皮覆盖变性真皮修复深Ⅱ度烧伤创面的可行性提供实验依据。方法在大鼠背部造成直径3.5cm深Ⅱ度烧伤创面。伤后2—5d行创面浅层削痂保留变性真皮,同时在局部移植大张自体断层皮片。移植前和移植后不同时相点分别切取植皮区全层皮肤,光镜下观察其形态学及胶原纤维变化,并检测其生物力学改变。取移植大鼠同体背部正常皮肤作为对照指标。结果(1)保留的变性真皮为玻璃样变性。(2)大鼠自体皮移植术后7d,皮片与创面融合无法分离,光镜下可见真皮乳头及网状层。术后21d移植部位皮肤厚度、结构、形态与正常组织相似,有萎缩毛囊,胶原纤维条索密度逐渐增大接近融合。(3)鼠皮抗拉强度、最大应变值在术后逐渐增大,至60d时接近正常。结论将自体皮覆盖于变性真皮上用以修复深Ⅱ度烧伤创面,变性真皮能够逐渐复苏,使其结构、形态接近正常。     

新型增生性瘢痕裸鼠动物模型的建立

目的　建立一种稳定的增生性瘢痕 (HS)动物模型 ,为进一步研究HS的发病机制提供帮助。　方法　在 10 0只裸鼠背部分别作 2 .0cm× 1.5cm全层皮肤缺损创面 ,移植人全厚皮肤 ;皮片存活后用加热的铜棒造成深Ⅱ度烫伤 ,观察创面愈合后的瘢痕增生情况。　结果　皮片完全存活的 86只裸鼠中 ,6 7只有明显、持续的瘢痕增生 ,占 78%。增生瘢痕的外观和组织学特点与人体增生性瘢痕相似。瘢痕增生的平均厚度为 0 .34cm,最厚 0 .6 0cm,增生时间为 6 3～ 2 17d,平均 12 8d。结论　该模型瘢痕增生明显、增生持续时间长 ,可用于观察创面愈合至瘢痕形成的全过程 ,是目前较为稳定的增生性瘢痕动物模型。     

复合皮移植的实验研究与临床应用

目的寻求一种较理想的真皮替代物,用以修复全厚皮肤缺损创面。方法(1)将异体／异种脱细胞真皮基质(allo／xeno-ADM) 自体刃厚皮组成复合皮(CS),以自体刃厚皮作对照,采用一步移植法进行实验研究和临床研究。移植术后应用生物化学及免疫学方法观察移植物抗原性的改变、表皮一真皮连接区(DEJ)基底膜带结构的再形成情况。(2)在此基础上,应用前述CS移植技术治疗53例全厚皮缺损或瘢痕切除患者,观察术后皮片成活情况并作随访。结果CS一步法移植后的成活情况良好。(1)移植后28周可见DEJ基底膜带重新形成,基底膜细胞呈极性生长并呈波浪形排列,真皮乳头与皮钉再生。allo-ADM的抗原性明显低于xeno-ADM,仅在术后早期有少数炎性细胞浸润,未见明显的免疫排斥反应。(2)移植于53例患者的70块CS中,65块完全存活占92．9％,2块因更换敷料不当部分存活,3块因创面感染移植失败。患者最长随访时间为8．5年,所移植的CS质地和色泽接近正常皮肤。结论allo／xeno-ADM的抗原性很低,移植后能发挥长期的真皮支架或诱导组织再生的真皮“模板”作用。     

全颜面部深度烧伤的临床治疗

目的探讨提高患者全颜面部深度烧伤创面修复质量的处理方式。方法将54例全颜面部深度烧伤患者分为延期植皮组(48例)和早期切痂组(6例)。伤后3周对延期植皮组患者实施剥、削痂或手术刀柄刮除新生肉芽组织至基底层,在全颜面部分区进行自体中厚皮片移植术;早期切痂组患者于伤后1周行切痂术,其他处理同延期植皮组。观察两组患者首次手术时间、面部手术时间、手术总次数、手术前后血红蛋白(Hb)浓度、术中输血量及出血量,随访观察患者治愈后的情况。结果两组患者的首次手术时间、手术总次数、手术前后Hb浓度及术中输血量比较,差异无统计学意义(P>0．05)。延期植皮组患者面部手术时间为(21．9±3．2)d,较早期切痂组(12．6±1．3)d晚 (P<0．05);延期植皮组术中出血量(98±52)ml/100 cm2,明显少于早期切痂组(331±121)ml/100 cm2(P<0．01)。延期植皮组患者创面愈合后较早期切痂组面部外观丰满,皮肤弹性好,表情丰富。术后两组患者均出现不同程度小口畸形、双眉缺失,80％的患者出现睑外翻,皮片缝接处遗有增生性瘢痕等,经多次整形手术予以矫正。结论全颜面部深度烧伤患者行自体中厚皮片分区移植,创面无论采用早期切痂,还是延期剥、削痂或完全清除新生肉芽组织至基底层,均可取得较为满意的治疗效果;与前者相比,后者术中出血少,术后外观、功能恢复好;同时术后有效的物理治疗和有计划地进行后遗畸形整形手术,也是保障其治疗效果的重要因素。     

Efficacy of hydrosurgical excision combined with skin grafting in the treatment of deep partial-thickness and full-thickness burns: A two-year retrospective study

IntroductionDeep partial-thickness and full-thickness burn wounds often undergo tangential excision or escharectomy to expose healthy tissue, combined with skin grafting to promote wound healing. However, conventional tangential excision with the humby knife leads to inevitable damage to the dermis while excising burn tissue due to the lack of precision. Indeed, the preservation of dermal tissue is a key factor in determining wound healing and scar quality. The precision and tissue selectivity of the Versajet Hydrosurgical System has been established for excising burn tissue while preserving dermal tissue. In this study, we retrospectively compared the efficacy of "Hydrosurgical excision combined with skin grafting" and "Conventional tangential excision combined with skin grafting" in treating deep partial-thickness and full-thickness burn wounds to demonstrate that hydrosurgery improved the treatment of deep partial-thickness and full-thickness burns.MethodsA total of 86 patients with deep partial-thickness and/or full-thickness burns with a total burn surface area (TBSA) ≤ 25% from July 2018 to July 2020 were included in this study and were divided into experimental (hydrosurgical excision combined with skin grafting, n = 43) and control (conventional tangential excision combined with skin grafting, n = 43) groups. Parameters were analyzed, including the intraoperative blood loss volume per unit area of grafted skin, surgery duration, wound healing time, skin graft survival, and the treatment costs per unit of burned area. Scar assessment was performed at 1 year with the modified Vancouver Scar Scale linked with TBSA (mVSS-TBSA).ResultNo significant difference was found in male to female ratio, age, weight, TBSA, burn depth, skin grafting area (SKA), skin grafting methods, cases treated with carbon dioxide fractional laser or incidence of inhalation injury, and the incidence of hypovolemic shock between two groups(p > 0.05). Compared with the control group, patients treated with hydrosurgical excision combined with skin grafting experienced less intraoperative blood loss volume per unit area of grafted skin (p < 0.05). The mVSS-TBSA of patients that underwent hydrosurgical excision combined with skin grafting was significantly improved in comparison to the control group (p < 0.01). No significant difference was found in surgery duration, wound healing time, skin graft survival and treatment costs per unit of burned area between the two groups (p > 0.05).ConclusionHydrosurgical excision combined with skin grafting reduced intraoperative blood loss volume per unit area of grafted skin, improved scarring 1-year after injury, and did not increase the treatment costs per unit of burned area. This technique provides a novel alternative for managing deep partial-thickness and full-thickness burn wounds.     

Reconstruction of facial burn sequelae utilizing tissue expanders with embodiment injection site: case report

Although highly specialized burn centers have significantly reduced mortality rates following extensive total body surface area burns, survivors are often left with grotesque facial disfigurement. Hypertrophic scars and tissue defects are the most common cause of functional and aesthetic problems in the head and neck region. Plastic surgeons use full-thickness or split-thickness skin grafts, pedicled flaps, free flaps, transplantation of bone or cartilage and tissue expansion. The authors present a case of a patient who suffered from third-degree flame burns to the face. Prior skin grafting procedures left him with severe scar deformity of the face. The patient was treated utilizing multiple tissue expansion. Facial animation has retained and facial integrity has been aesthetically restored and, with the use of make-up, it is near normal in social settings at conversational distances. The tissue expansion technique is advantageous in facial reconstruction because it makes it possible to resurface even wider defects with neighboring skin, similar in colour and texture, and superior to skin obtained elsewhere.     

早期保守去痂延期植皮治疗颜面深度烧伤

目的：探讨颜面部深度烧伤后,预防局部瘢痕增生和畸形的最好治疗方法。方法：颜面部深度烧伤早期,采用保守削痂,延期植皮和双眼睑早期减张,扩张创面立即植皮的处置方式,结果：本组12例患于伤后3周内创面全部愈合。随诊未发现明显瘢痕增生和畸形,面部表情自然,情绪表达充分。结论：应用早期保守去痂延期植皮的方法,可促进全颜面创面尽快修复,减少瘢痕增生和颜面畸形的发生。     

烧伤早期切痂脱细胞异体真皮基质与自体皮浆复合移植的临床应用

目的探讨脱细胞异体真皮基质与自体皮浆复合移植的可行性。方法在8例患者Ⅲ。烧伤创面早期切痂,13个部位采用18块脱细胞真皮基质移植固定,在异体皮的真皮面上均匀涂布备好的皮浆,覆盖于脱细胞真皮基质上,缝合包扎固定。同一肢体其余创面常规用自体皮浆加异体皮移植做对照观察,皮浆与创面比例为1：5～1：8。结果18块脱细胞异体真皮基质复合移植皮肤成活率94％,随访3～13个月皮肤弹性及色泽好、瘢痕轻、耐磨,愈合质量优于对照部位创面。术后3个月组织切片表皮真皮连接紧密,可见钉突样结构,胶原纤维排列较规整;单纯皮浆移植皮肤为瘢痕皮肤结构。结论应用脱细胞真皮基质与自体皮浆复合移植,明显优于单纯的皮浆移植,具有较好的临床应用前景。