Meek植皮术在特大面积烧伤创面修复中的应用

目的了解Meek植皮术在特大面积烧伤创面修复中的治疗效果。方法选取烧伤总面积≥80%TBSA,Ⅲ度烧伤面积≥30%TBSA的患者32例,给予常规抗休克、抗感染、脏器功能支持、营养支持、创面处理等治疗。将32例患者随机分为Meek植皮术组17例,微粒皮移植术组15例,对两组患者的Ⅲ度及部分深Ⅱ度创面分别采用Meek植皮术和微粒皮移植术修复,对比观察两组患者的植皮区皮片融合时间、疤痕增生情况及对关节活动的影响。结果 Meek植皮术组,皮片成活率50%～100%,平均88%,皮片融合时间与供区受区扩展比例1︰3的为7～10d,1︰4的为10～15d,1︰6的为13～18d,1︰9的为15～23d;3～18个月后随访,疤痕增生轻,呈网状,关节处疤痕挛缩不严重,关节疤痕松解植皮手术率低。微粒皮移植术组,微粒皮成活率33%～85%,平均52%,供区受区扩展比例为1︰8～1︰12,皮片融合时间为21～45d,平均32.5d,创面一类愈合率为55.5%,二类愈合率为44.5%;3～24个月后随访,疤痕增生呈条索状或片状,关节活动较差,关节疤痕松解植皮手术率高。结论在有相对充足自体皮源的情况下,对特大面积深度烧伤创面采用Meek植皮术修复,是一种较好的方法。

Meek dermoplasty in the reparation of particular big burn wounds

Objective To investigate the therapeutic efficacy of Meek dermoplasty in the particular big burn wounds.Methods Thirty-two patientswere selected,whose total burn area was greater than 80%of total body surface area（TBSA）and the third-degree burns larger than 30%TBSA,applying conventional anti-shock,anti-infection,organ support,nutritional support,raw surface,etc.They were randomly divided into two treatment groups.Meek skin graft group：17 patients with the deep second and third-degree wounds were treated with micro skin graft Meek technology repair;the control group：15 cases of third-degree and some of the deep second-degree wounds were treated with skin grafting for repairing particles.Chapi chip integration time,scarring proliferation situation and the joint activities were compared between the two groups.Results In Meek skin graft group,skin graft survival rate was 50%to 100%,an average of 88%;skin graft integration time：expansion ratio of 1：3 for 7 to 10 days,1：4 for 10 to 15 days,1：6 for 13 to 18 days,1：9 for 15 to 23 days. After 3 to 18 months follow-up,scar hyperplasia showed light and reticular.Scar contracture of joint was not serious and joints loosen and skin grafting rate was low.In Particulate skin graft group,for the subject area the average ratio was1：11.2,healing time was 21 to 45days,averaged 32.5 days;primary healing rate was 55.5%,secondary healing rate was 44.5%.Three to 24 months after the follow-up,hypertrophic scar showed cord-like or flake,poor joint activities,for joints loosen scar high rate of skin grafting poor.Conclusion In a relativ abundant source of autologous skin cases,meek skin grafting is an effective way to repair large area deep burn wounds and postoperative joint function is less affected.