复合皮混合移植治疗深Ⅱ度烧伤患者创面疗效观察

Observation of the effect of the mixed composite skin graft on deep partial thickness burn wounds

目的观察深Ⅱ度烧伤患者创面削痂术后应用复合皮混合移植治疗的效果。方法对23例烧伤患者的30个深Ⅱ度烧伤肢体在伤后3d内分次行削痂术,削至浅筋膜后移植大张异体脱细胞真皮基质,然后切取大张自体刃厚皮(0.10～0.25mm)覆盖于其上。术后10—12d计算移植皮片的存活率,记录创面愈合时间。观察随访3—6个月时患者的肢体外观及功能恢复情况。取1例患者随访3个月时的愈合创面皮肤标本,行病理学观察。结果本组患者复合皮片成活率为93%,7%的皮片因术中固定较差,移植后自体刃厚皮与异体脱细胞真皮基质分离致皮片坏死,或因感染致皮片溶解。随访3—6个月,移植部位皮肤外观、弹性及功能恢复良好。病理学观察显示,成活皮片表皮、真皮结构正常。结论烧伤后早期削痂立即移植复合皮是治疗深Ⅱ度创面的有效方法。

Objective To evaluate the effect of mixed composite skin graft on the deep partial thickness burn wounds after tangential excision in burn patients. Methods Tangential excision was performed in 30 extremities of 23 burn patients within 3 postburn days (PBDs).Then large pieces of homologous acellular dermal matrix were grafted onto the superficial fascia with razor thin autoskin on top of them. The survival rate of skin grafts, the appearance and the functional recovery of the extremities were observed on 10 to 12 post operative day (POD).Skin samples from a healed wound of a patient were harvested three months after the injury for pathologic examination. Results The survival rate of the composite skin grafts was 93%.Necrosis was encountered in 7% of the grafts in the lower extremities due to the poor fixation of the grafts leading to separation of autologous skin and the dermal template,and also due to infection resulting in lysis of the grafts. The grafted skin was excellent in the appearance and elasticity,and function of the injured extremities recovered well after grafting after 3—6 months of follow-up.Epidermal and dermal texture was also good as shown by pathologic examination. Conclusion Mixed composite skin grafting after early tangential excision might be an ideal and effective method in the management of deep partial thickness burn wounds.