人工真皮联合VSD及自体刃厚皮片移植治疗烧伤后瘢痕增生的疗效及影响因素分析

Effect and Influencing Factors of Artificial Dermis Combined with VSD and Autologous Blade Thickness Skin Grafting in the Treatment of Scar Hyperplasia after Burn

目的:探讨人工真皮联合负压封闭引流(Vacuum sealing drainage,VSD)及自体刃厚皮片移植治疗烧伤后瘢痕增生的疗效,并分析影响其术后疗效的相关因素。方法:选取笔者医院2017年6月-2020年3月收治的烧伤后瘢痕增生患者106例作为研究对象。所有患者沿瘢痕与正常皮肤边界完整切除瘢痕组织,行人工真皮联合VSD及自体刃厚皮复合移植治疗。对患者疗效进行评价,并于治疗前后检测瘢痕厚度,采用温哥华瘢痕量表(Vancouver scar scale,VSS)对瘢痕情况进行评分。根据患者疗效情况将所有患者分为有效组和无效组,并记录其相关临床资料,采用单因素分析和多因素Logistic回归模型分析影响患者术后疗效的相关因素。结果:106例患者治疗后有效率为92.45%(98/106)。治疗后,患者瘢痕厚度、VSS评分均低于治疗前,差异有统计学意义(P<0.05)。单因素分析显示,瘢痕部位、创面深度、瘢痕增生时间、瘢痕厚度、瘢痕柔软度、瘢痕体质均与患者术后疗效情况有关(P<0.05)。多因素Logistic分析表明,创面深度、瘢痕厚度、瘢痕柔软度、瘢痕体质均是术后疗效情况的独立影响因素(P<0.05)。结论:人工真皮联合VSD及自体刃厚皮片移植治疗烧伤后瘢痕增生疗效好,能够有效减少瘢痕厚度,改善瘢痕情况,值得推广。创面深度、瘢痕厚度、瘢痕柔软度、瘢痕体质均与烧伤后瘢痕增生治疗效果有关。

Objective To investigate the efficacy of artificial dermis combined with VSD and autologous blade thickness skin grafting in the treatment of post-burn scar hyperplasia,and to analyze the related factors that affect the postoperative efficacy.Methods 106 patients with post-burn scar hyperplasia admitted to our hospital from June 2017 to March 2020 were selected as the research objects.All patients underwent complete excision of scar tissue along the boundary between scar and normal skin,and were treated with artificial dermis combined with VSD and autologous blade thickness skin grafting.The patient’s curative effect was evaluated,and the scar thickness was measured before and after treatment.Scars were scored by VSS.According to the patient’s efficacy,all patients were divided into the effective group and the ineffective group,and their relevant clinical data were recorded,and the single factor analysis and multivariate logistic regression model were used to analyze the relevant factors affecting the postoperative efficacy of the patients.Results The effective rate of 106 patients after treatment was 92.45%(98/106).After treatment,the patient’s scar thickness and VSS score were lower than before treatment,and the differences were statistically significant(P<0.05).Univariate analysis showed that scar site,the depth of the wound,the time of scar proliferation,the thickness of scar,the softness of scar,and scar diathesis were all related to the postoperative curative effect(P<0.05).Multivariate Logistic analysis showed that depth of the wound,the thickness of scar,the softness of scar,and scar diathesis were all independent factors influencing the postoperative efficacy(P<0.05).Conclusion Artificial dermis combined with VSD and autologous blade thickness skin grafts have good curative effects in treating patients with post-burn scar hyperplasia,which can effectively reduce the thickness of scars and improve the scar condition,and is worthy of promotion.The depth of the wound,the thickness of scar,the softness of scar and scar diathesis are all related to the postoperative curative effect of scar hyperplasia after burn.