金属框架打包植皮法在面部植皮中的应用☆

背景：颜面部打包植皮是传统的皮片固定方法，但在皮片的固定、成活质量、术后皮片挛缩及外观上存在不足，应不断完善。 目的：试验拟观察应用改进的金属框架打包植皮法对提高颜面植皮成活质量的影响。 设计、时间及地点：观察性试验，于2003-01/2007-12在北京积水潭医院烧伤科完成。 对象及材料：选择本科收治的颜面部烧伤和烧伤后瘢痕畸形的患者23例，男16例，女7例，平均年龄（37±18）岁。手术植皮部位32处，面颊部8处，眼睑部20处、口周部4处。手术中应用的金属框架材料为医用不锈钢材质的1.0~1.5号克氏针，消毒后术中根据植皮创面形状用钳子弯制而成；术中应用的橡皮筋和回形针为普通文具用品，经环氧乙烷消毒后应用。 方法：所有患者均应用金属框架打包植皮法于32处面部进行植皮，最大植皮面积为18 cm×10 cm。常规植皮缝合后周边应用1.0~1.5号克氏针按创面形状制成环形金属框架，随后打包固定移植皮片，三四周拆除金属框架。 主要观察指标：于术后拆除打包包扎时，观察记录皮片成活情况，包括皮片成活率、植皮边缘是否有边缘突起中央凹陷的“火山口现象”；术后三四周拆除金属框架时，观察皮片是否有小于框架的早期挛缩现象，并照相记录。对有可能进行长期随访的病例观察皮片长期的挛缩情况。 结果：23例患者32处创面，除1处因基底扩创不彻底部分皮片坏死外，其余31处创面植皮均成活良好，皮片平整，未出现边缘突起中央凹陷的“火山口现象”，至术后三四周拆除金属框架时，移植皮片面积与手术时维持一致，未出现早期挛缩。随访1年以上的病例皮片挛缩轻，外观满意。 结论：改进的金属框架打包植皮法可提高颜面植皮的成活质量，减轻皮片挛缩。

Use of wire frame tie-over to fix the facial skin grafts

BACKGROUND: Facial tie-over is a conventional method for skin graft fixation, but it needs further improvements due to the unsatisfactory fixation, survival quality, postoperational contraction and appearance. OBJECTIVE: To improve the survival quality of facial skin grafts using the modified wire frame tie-over for the fixation. DESIGN, TIME AND SETTING: An observation trial was carried out at the Department of Burns in Beijing Jishuitan Hospital from January 2003 to December 2007. PARTICIPANTS AND MATERIALS: A total of 23 patients suffered from facial burns and post-burn scar were enrolled from the Department of Burns in Beijing Jishuitan Hospital, 16 males and 7 females, with a mean age of (37±18) years. The wire frame tie-over skin grafts were used in 32 facial wounds, including 8 cheek wounds, 20 eyelid wounds and 4 perioral wounds. The 1.0-1.5 Kirschner wire frame, made of stainless steel, was shaped as the wound outline; the rubber bands and clip were sterilized with ethylene oxide. METHODS: All the patients were grafted by means of wire frame tie-over, and the maximal area of skin graft was 18 cm×10 cm. After the routine skin grafting, the Kirschner wire frame was sutured to the edge of wound, then tie-over was performed using the sutures or the sterilized rubber bands fixed on the wire frame. The wire frame was removed three to four weeks after operation. MAIN OUTCOME MEASURES: The survival of skin grafts was recorded at the removal of tie-over, including survival rate of skin grafts and appearance of crater phenomenon that was prominent at edges and depressed in center; The skin grafts were pictured to observe the early contraction at the removal of wire frames 3-4 weeks later. The patients who were potential for the long-term follow-ups were used to observe the long-term contraction. RESULTS: Among 32 wounds in 23 patients, 31 skin grafts had an excellent skin grafting, except a partial graft necrosis occurred in one case due to insufficient debridement. The skin grafts were flat and intact, no crater phenomenon was found. Three or four weeks after operation, the area of skin grafts maintained in original style, no early contraction was found. One year later, the patients appeared mild contraction of skin graft, and the skin appearance was satisfactory. CONCLUSION: Improved wire frame tie-over method can increase the survival quality of facial grafts and alleviate the graft contraction.