IV度烧伤骨外露创面的修复

目的：总结修复Ⅳ度烧伤骨外露创面的经验.方法：1994-04～2004-12,采用5种不同的修复方法治疗61例102处Ⅳ度烧伤骨外露创面,对其临床治疗与随访资料进行分析总结.结果：除修复3例3处长管状骨外露创面的皮片完全坏死,板障层移植皮片成活率约为90%外,其余皮片、皮瓣和扩张皮瓣均100%成活,伤口一期愈合.15个扩张囊经超量注水,扩张容量达到390～820 ml,注水过程中无1例发生并发症.术后随访1～15个月,创面愈合良好,毛发生长满意.结论：骨髓面或板障层皮片移植术可用于修复短管状骨或板状骨外露,但不能用于长管状骨外露创面的修复;在条件允许的情况下皮瓣或筋膜瓣可用于修复各种骨外露创面;头皮扩张术是修复颅骨外露创面的良好方法.

Repair of fourth degree burn wound with bone exposure

Objective:To sum up the experience in repairing fourth degree burn wound with bone exposure.(Methods:) From Apr.1994 to Dec.2004,five surgical methods were employed to treat 102 fourth degree burn wounds with bone exposure in 61 patients.Their clinical materials and follow-up results were analyzed.Results: The skin grafts transplanted on the marrow surface of the long bone could not survive,and the survival rate of the skin graft transplanted on the diploic layer of the flat bone was about 90%.The survival rates of other skin grafts,skin flaps and expanded skin flaps were 100%,and the wounds healed on the first stage.The(expanded) capacities of 15 expanders reached 390~820 ml by overloaded injection.No any complications occured during the expanding process.The follow-up results from one month to fifteen months post-operation showed satisfactory wound repair.Conclusion:Skin grafting on the marrow surface or diploic layer can be used to repair short bone or flat bone(exposure) wound,but can not be used to repair long bone exposure wound.Skin flap and fascia flap might be(employed) to repair various bone exposure wound under the given condition.Scalp expanding is a good method to(repair) cranial bone exposure wound.