大面积Ⅲ度烧伤切痂创面不同修复方法效果观察

目的:回顾性分析大面积Ⅲ度烧伤切痂创面的3种修复方法,探求真皮替代物在提高创面愈合质量的意义和价值。方法:总结笔者单位近15年来收治的大面积烧伤一次切痂面积15%TBSA以上,分别采用大张异体(异种)皮肤打洞小块自体皮嵌植法(简称“嵌皮法”),自体皮肤微粒播散移植外层覆盖异体(异种)皮肤法(简称“微皮法”)和自体皮肤细胞耕耘播种于异体真皮内移植法(简称“皮肤细胞法”),治愈出院,随访2月以上的210例患者病例资料,以术后30d和45d上皮化愈合面积占手术面积百分率及是否需补充植皮作为疗效判定标准,30d达80%以上或45d达95%以上且无需补充植皮者为优;30d在50～80%,或45d在81～94%,且此后可能需补充植皮者为良;30d在50%以下,或45d不足80%且此后需补充植皮者为差。结果:①自体皮扩大比例“嵌皮法”<“微皮法”<“皮肤细胞法”。②3种修复方法总优良率91.4%,3种方法间优良率无差异。③“皮肤细胞法”发现大部分异体真皮长时间无干枯坏死现象,异体真皮表面形成新生上皮,活检切片显示上皮细胞于异体真皮内呈团状增殖分化,14个月切片表明,除不含皮肤附属器外,既有致密的全层表皮结构,又有真皮组织结构,术后随访5年,愈合区皮肤似移植大块自体中厚皮,柔软,光滑和平坦。结论:“嵌皮法”、“微皮法”和“皮肤细胞法”均可作为大面积Ⅲ度烧伤创面的修复方法,以“微皮法”较常使用。“皮肤细胞法”因发现大部分真皮长时间未被排异,值得进一步观察。

Observation of the effect of several management methods on the postburn massive escharectomy in full-thickness skin burn wound

Objective: To analyze three methods of wound repair for full thickness burn escharectomy wound retrospectively, so as to evaluate the significance of dermal substitute in improving wound healing.Methods: Burn patients admitted to our department and escharectomy more than 15%TBSA one time in 15 recent years were enrolled in this study. These methods were allo-skin/xeno-skin holed plus small auto-skin embedded (embed skin); auto-microskin covered with allo-skin/xeno-skin (auto-microskin);auto skin cell tillage in allo-skin (auto-skin cell). All patients were cured and discharged.According to 210 case data followed up for more than two months, the curative standard were heal rate in 30 days , 45 days, and whether another grafting is necessary. The excellent were that heal rate was more than 80% in 30 days or more than 95% in 45 days, another grafting is not necessary; The good were that heal rate was from 50% to 80% in 30 days or from 81% to 94% in 45 days, another grafting maybe is necessary; The bad were that heal rate was below 50% in 30 days or below 45% in 45 days, another grafting is necessary. Results: ①From low to high ,auto-skin extension rate was embed skin, auto-microskin, auto-skin cell.②The general heal rate were 91.4%,there were no difference among three methods.③Most allo-dermis was still alive in auto-skin cell method ,the new born epidermis was formed on allo-dermis, epithelium proliferated in allo-dermis from HE slice. It also showed that both compacted epidermis frame and dermis structure existed ,excepted the skin appertain in 14 months .The healed skin was similar to big auto-partial thickness skin, which was tender, velvet, and flat in 5 years.Conclusion: All the embed skin, auto-microskin, auto-skin cell methods could used in full-thickness skin burn escharectomy wound retrospectively, but auto-microskin method was often used . The skin cell method deserves the further observation because of discovering that allo-dermis was not ejected in long time. big and parts of leather long times don't be line up the difference.