微粒皮移植治疗大面积深度烧伤后关节瘢痕挛缩的初步体会

目的 探讨大面积深度烧伤病人自体微粒皮与大张异体皮移植术治疗关节部位瘢痕挛缩的方法.方法 选择大面积深度烧伤后期瘢痕严重增生挛缩造成关节畸形而自体皮匮乏的病人11例,共31个关节,在全麻下切除部分瘢痕,彻底松解,矫正关节畸形,用微粒皮加异体皮覆盖创面,术后进行植皮区压迫和早期功能锻炼.随访12个月以上.通过术前、术后的皮肤外观、关节功能、组织学观察等进行效果评价.结果 微粒皮移植者皮肤外观及关节功能明显改善;组织学可见表皮较厚,部分可见表皮脚,真皮层较薄,胶原纤维排列较有规律.结论 微粒皮加大张异体皮移植术可用于治疗大面积深度烧伤病人关节部位瘢痕挛缩.

A preliminary study on correction of scar contracture of joints with minced skin autograft after severe extensive burn

Objective To explore a method for correction of scar contracture of joints with minced skin autograft after severe extensive burn. Methods In total 11 patients who suffered from scar contracture after in 31 joints severe extensive burn, the scars were dissected in part under general anesthesia to improve mobility and correct deformity of joints, and the wounds were covered with minced skin autograft. After operation, the patients were guided to press the wound sites and do proper exercises early, and followed-up for over 12 months to evaluate skin appearance, joint function, and histological behavior. Results The patients treated with minced skin autografting showed improvement in skin appearance and joint function. Histological findings revealed thick epidermis and thin dermis with orderly arranged collagen fibers. Conclusion Transplantation of minced skin autograft along with large skin allograft is a candidate method for correction of scar contracture of joint in patients with severe extensive burn.