大面积烧伤早期切痂微粒皮移植中功能部位不同方式复合皮移植的应用

目的总结大面积深度烧伤早期切痂微粒皮移植同时进行功能部位不同方式复合皮移植的经验,并探讨其治疗意义。方法 2002年4月-2011年11月收治的31例病人在大面积切痂微粒皮移植同时,功能部位54处行复合植皮术,其中脱细胞异体真皮基质(ADM)+自体超薄皮片复合移植42处,微粒皮下移植异体ADM12处。结果微粒皮+异体ADM超薄皮片复合移植成活率95%,微粒皮下异体ADM移植存活66%;术后随访复合皮移植的功能部位活动良好,瘢痕挛缩不明显,未出现明显皲裂及水疱,但遗留色素变化。局部外观及弹性以异体ADM超薄皮片复合移植效果更佳。结论烧伤早期切痂自体微粒皮移植修复创面同时对肢体功能部位联合进行复合皮移植术对于减少手术次数,促进创面尽快封闭,提供供皮区再次利用条件,保护肢体功能具有积极意义。而异体ADM超薄皮片复合移植无论存活率还是术后功能恢复均较微粒皮下ADM移植为佳。

Different way of compound skin transplants on function spot accompany with escharectomy and micro-skin grafting in early times of severe burns

【Objective】 To summarize the experiences in different method of compound skin grafting accompany with escharectomy and micro-skin grafting in early times of severe burns.【Methods】 Fifty-four function spots of Thirty-one patients undergoes surgery of compound skin grafting during escharectomy and micro-skin grafting.In which 42spots by acellular allogeneicdermal matrix（ADM） with thin autogenic skin grafting and 12 places by ADM under auto microskin and allo skin.【Resluts】ADM with thin autogenic skin grafting survival rate 95%,ADM under auto microskin and allo skin grafting survives 66%;After the technique makes a follow-up visit the function spot activity which the compound skin transplants to be good,the scar luan shrinks not obviously,and not appeared chaps obviously and the water blister,but carry-over pigment change.The partial outward appearance and the elasticity are better by the ADM with thin autogenic skin grafting effect.【Conclusion】 The compound skin transplant technique jointly to the body function spot while escharectomy and micro-skin grafting carried on in early time of burns regarding the reduced surgery number of times,promotes the injured area to seal up as soon as possible,provides uses the condition once more for the skin area,protects the body function to have the positive sense.ADM with thin autogenic skin grafting regardless of the survival percentage or the technique the function restores compares ADM grafting under auto microskin and allo skin for good.