早期微创性磨削治疗面部深Ⅱ度烧伤

Management of deep second degree facial burn wound by microtrauma dermabrasion during early postburn stage

目的:探讨面部深Ⅱ度烧伤治疗的最佳方法。方法:选择140例成人烧伤总面积2%～48(%儿童1%～10%)、头面部以深Ⅱ度烧伤为主的患者,随机分为三组,试验组于伤后2～3天行磨削、搔刮、削痂综合治疗,覆盖异体皮保护创面;对照手术组同期行单纯削痂,0.5%碘伏油纱包扎创面;对照换药组用SD-Ag霜进行换药治疗。分别观察手术去除坏死组织和消除肿胀、术中出血量、创面愈合情况等,并随访观察瘢痕增生情况。结果:患者血容量是否充足的指标、有无并发症的产生,试验组与对照组比较均无差异(P>0.05),试验组在去除坏死组织和消除肿胀方面,与传统削痂术相似,无显著性差异(P>0.05)。在出血量方面,每1%TBSA的出血量试验组(8.1ml±6.4ml)较对照手术组(13.9ml±11.5ml)明显减少(P<0.05)。试验组创面平均愈合时间(13.32±1.57)天,较对照削痂组(22.37±5.39)天及对照换药组(36.89±5.32)天均明显缩短(P<0.05),试验组在愈合质量及瘢痕增生方面,疗效明显优于对照削痂组和对照换药组(P<0.05)。结论:磨、刮、削痂综合治疗面部深Ⅱ度烧伤,不受面部凹凸处的限制,磨削痂的深浅度易掌握,既有效清除坏死组织,又最大程度的保留间生态上皮,比传统削痂术损伤轻,符合整形外科微创手术的技术要求,瘢痕增生明显减少,色素沉着少,提高了创面愈合质量。

Objective To find out the best method for treating deep-Ⅱ facial burn wounds. Methods 140 adults patients with TBSA between 2%-48% （children 1%-10%） and deep-Ⅱ facial burn wounds, were randomly divided into 3 groups.One group was served as the experimental group receiving comprehensive treatment including Dermabrasion,scrape scab,tangential excision and then covering with allogeneic skin.One group was served as the control group I receiving tangential excision treatment and covering with gauge containing iodide.The other group was served as the control group Ⅱ receiving treatment with SD-Ag.The capacity of eliminate necrotic tissue and strut,the amount of blood during the operation and wound healing were observed,including cheloid. Results There was no difference between experimental group and the other two control groups （P〉0.05） in the amount of blood and the patients,complications.The method of the experimental group can eliminate more necrotic tissue than that of the control group I,but it was similar to that of the control group I in eliminating strut （P〉0.05）.The amount of blood per 1% TBSA in experimental group （8.1ml±6.4ml） was significantly less than that in control groupl（13.9ml± 11.5ml） （P〈0.05）. The wound healing time in experimental group （13.32±1.57）days was also significantly less compared with that （22.37±5.39）days in control group Ⅰ and that（36.89±5.32）days in control group Ⅱ.Curative effect of experimental group in wound healing and cheloid was better than that of the other two groups （P〈0.05）. Conclusion The comprehensive treatment was not restricted by the accidented of the face in treating deep-Ⅱ facial burn.Using this method,it was easily to control the depth of wound.This method can eliminate the necrotic tissue effectively and to the most extent, can reserve the health epidermal. So this method was much better than traditional method.