儿童头颈部深度烧伤的临床治疗

目的探讨儿童头颈部深度烧伤的治疗方法和疗效。方法创面采用暴露疗法。头皮Ⅲ度创面去痂后行局部皮瓣转移修复或行游离皮片移植。伤后3周，颜面部创面剥痂削痂或刮除肉芽组织后分区行自体中厚皮移植术，颈部Ⅲ度同样移植自体中厚皮。创面愈合后行康复治疗。结果所有皮片移植手术均获得成功。颜面部外观丰满、皮肤富有弹性，缝接处有增生性瘢痕，全颜面深度烧伤者有不同程度的眼睑外翻、小口畸形、鼻翼畸形等。颜面部自愈创面压迫治疗区域瘢痕增生轻微。颈部深Ⅱ度创面后有不同程度瘢痕增生；植皮区无明显瘢痕增生，活动自如。结论儿童头颈部的深度烧伤创面移植中厚皮可获得较为满意的疗效，创面愈合后康复治疗同样至关重要，遗留的畸形或功能障碍可行整形手术解决。

The Clinical Treatment Analysis of the Children's Deep Head-neck Burns

Objective To investigate the method and the effect of the children＇s deep head-neck burns. Methods Various wounds were managed by exposition. The third degree wounds on the scalps were recovered by local skin flaps transplantation or auto skin grafting after eschar had been removed; At 3 post-burn weeks, the third degree wounds on the faces and the necks were recovered by split thickness auto skin in separate regions after eschar peel- ing, tangential excision and granulation tissues scaling had been performed, then rehabilitative treatment for postburn scar were applied. Results All operations of auto skin grafting were successful. The facial appearance of the patients was plump,and the facial skin of the patients was elastic, hypertrophic scar was left on the conjunctions of grafted skin, there were different degree of microstomia, eyelid ectropion, nose deformity etc. The facial areas of self- repairing had only slight scar after these patients were given pressure-treated. There were mild to moderate hypertrophic scar on the necks after the patients with deep Ⅱ degree wounds had healed, but no obvious hypertrophic scar was observed on the necks of the the patients who had been applied auto-grafting, the patients made free with their movement of the necks. Conclusion Split thickness skin grafting can give satisfying results for the children＇ s deep head-neck burns, meanwhile, rehabilitation is also vital to treatment, plastic operation can be used to solve the problem of deformity and dysfunction.