不同厚度真皮组织缺损与增生性瘢痕形成的关系

The clinical study of the relationship between the defect of different thickness dermal tissues and the proliferative scar formation

目的探讨损伤后不同厚度真皮组织缺损与增生性瘢痕发生之间的关系。方法选择四肢部位供皮区共32处作为研究创面,分为刃厚皮供皮区(A组)、中厚皮供皮区(B组),再根据是否移植具有一定厚度的自体皮片,将A组分为A1组(刃厚皮不植皮组)、A2组(刃厚皮植皮组);将B组分为B1组(中厚皮不植皮组)、B2组(中厚皮植刃厚皮组)、B3组(中厚皮植中厚皮组)。留取所取皮片及移植皮片标本,计算机测量所取皮片及移植皮片的真皮厚度;术后6个月,应用温哥华瘢痕评估量表评估上述供皮区瘢痕形成及增生程度。结果A组缺损真皮厚度在0.146～0.163mm之间,B组缺损真皮厚度在0.456～0.656mm之间;随着真皮缺损的增加,愈合后瘢痕温哥华评分值也相应增加;缺失真皮的创面回植自体皮片后,其术后瘢痕评分值会相应减少,并与移植皮片厚度成反比。结论真皮组织缺损厚度与瘢痕增生的程度成正比,真皮组织的回植可减轻瘢痕增生。

Objective To explore the relationship between the defect of different thickness dermal tissues and the scar formation after burn injury. Methods The involved 32 donor sites of burn patients were divided into two groups: split thickness skin (Group A) and intermediate split thickness skin (Group B) from donor site. Meanwhile, according to condition whether autograft was necessary, Group A was divided into the following sub-groups respectively: group A1 (without autograft) and group A2 (split thickness autograft) and Group B into group B1 (without autograft), group B2 (split thickness autograft) and group B3 (intermediate split thickness autograft). The skin grafts either from donor site or autograft were collected for measurement of the dermal thickness by computer. The extent of the hypertrophic scars in donor site was also evaluated by Vancouver scoring system six months postoperatively. Results The dermal defect was 0.146-0.163 mm in Group A but 0.456-0.656 mm in Group B. The value of Vancouver scores became higher with increase of dermal defect but reduced when the lost dermis was regrafted to the wound. Conclusions It is proportional between dermal defect and scar formation. The scar proliferation would relieve if the dermis is regrafted to the wound.