早期削痂自体微粒皮与异体皮混合移植在深Ⅱ度烧伤创面的应用

目的探讨早期削痂自体微粒皮与异体皮混合移植,治疗深Ⅱ度烧伤创面的效果。方法对13例以四肢为主的深Ⅱ度烧伤患者,在4 8 h内行真皮内削痂术,保留部分真皮和浅筋膜。切取自体刃厚皮制作成微粒皮,通过漂浮法将微粒皮转移到复温处理后的大张异体皮真皮面,用其覆盖削痂后创面,缝合固定,加压包扎。5~7 d打开敷料,异体皮外涂碘酊,创面暴露。结果本组13例。一次手术治愈10例,再次手术植皮者3例,平均手术次数1.23次。平均创面愈合时间为(18.0±2.3)d。经5~12个月随访,供、受皮区未见明显瘢痕,皮肤外观、功能恢复较好。结论早期削痂自体微粒皮与异体皮混合移植治疗深Ⅱ度烧伤创面,可减轻感染、缩短疗程、提高治愈率和愈合质量。

Application of Early Eschar Shaving plus Combination of Automicrograft and Allogenous Skin to Deep Ⅱ°Burn Wound

Objective To discuss the effectiveness of early eschar shaving plus combined transplantation of automicrograft and allogenous skin on the wound of deep Ⅱ°burn.Methods Eschar shaving across dermis was applied to 13 patients with deep Ⅱ°burn(mainly on limbs) in 48 hours,and partial dermis and superficial fascia were saved.Razor-thin skin from themselves was made into automicrograft skin flaps,which were then transferred onto the dermic side of large piece of allogenous skin processed with temperature-restoring.The burn wound,whose eschar was shaved,was covered with large piece of allogenous skin with automicrograft skin flaps beneath its dermic side and bound up with pressed dressing after suture.The dressing was opened up for exposure after 5~7 days and iodic tincture was externally applied to the allogenous skin.Results Of the 13 patients,10 were healed up after one-time operation,and three were healed up after the second operation of skin-graft.The mean number of operative times was 1.23.The mean wound healing time was(18.0±2.3) d.There were no obvious scars in the area of donation or reception according to 5~12 months' follow-up.Skin appearance and function recovered well.Conclusion It is recommended that the combination of automicrograft and allogenous skin be applied to the treatment of deep Ⅱ°burn wound on the basis of early eschar shaving,for it makes an improvement in controlling infection,shortening therapeutic course and increasing healing rate.