不同干预因素对供皮区愈合的影响

The clinical research to improve the heal quality of the skin donor area

目的试图按循证医学的原则去探讨较厚供皮区的较好覆盖方法,以提高患者的生活质量。方法①不同生物敷料覆盖供皮区的观察:采用随机区组设计方法,将8例患者16鼓皮供区分为8个区组,每组4个创面。观察区分别行"L"、"Z-S"、"Z-Y"、"Z-J"覆盖。②复合皮与凡士林油纱覆盖供皮区的对比观察:选取后躯作供皮区,取皮厚度0.6mm,共23例,将1鼓供区创面一分为二,共46处创面,形成23个对子,随机选取1组应用"F"覆盖,对照区单用"L"。③皮下注液对取皮厚度的影响:当同时切取2鼓时,1鼓注液另一鼓不注液;当切取1鼓时,其中1/2注液,另1/2不注液。皮下注液完成后,同一医师用同一皮鼓切取同厚皮肤(0.6mm)。取皮结束时供皮区均应用凡士林油纱覆盖。用活检器分别取自游离皮肤组织注液区和非注液区各一块,置体积分数10%的中性缓冲甲醛中固定。结果从愈合天数上观察不同覆盖物中以"Z-S"组愈合最快,其次是"L"组,自愈最慢的是"Z-Y"组。"Z-J"组供区愈合后外观瘢痕增生程度及患者自诉瘙痒、疼痛程度明显减轻。"F"组瘢痕增生程度及患者自诉瘙痒疼痛程度最轻,外观接近正常皮肤;取皮前皮下注液后使得皮肤线向外推移,较少或不伤及网状深层,便于取得较薄的中厚皮,从而有利于供皮区愈合。结论对于中厚或厚中厚供皮区如条件允许采用脱细胞异体真皮加自体刃厚皮所形成的复合皮移植效果最好,桀亚敷料皮加自体微粒皮或生物敷料A加自体微粒皮进行供皮区覆盖、皮下注液后取皮等方法均有助于提高供皮区愈合质量。

Objective This research goal attempts to discuss how to cover the thick donor skin area and improve the patient＇s quality of life according to the principle of following evidence medicine.Methods First,use the randomized block design method,supplies 8examples patients 16 drums skins the discrimination is 8 block,each group of 4 injured areas.The observation differentiates other application＂L＂、＂Z-S＂、＂Z-Y＂、＂Z-J＂.Second.the selection the back body for the skin area,takes the thickness 0.6 mm,the altogether 23 examples,the altogether 46 injured areas,form 23 antithetical couples,stochastically selects 1 group for the observation area application＂F＂,The control farm plot only uses the＂L＂.Third,the under-skin infusing fluid method to takes the skin thickness influence.When simultaneously cuts takes 2 drums,1 drum note fluid another drum does not pour the fluid;When cuts takes 1 drum,1/2 note fluid,another 1/2 does not pour the fluid.After the skin under-skin infusing fluid completes,identical doctor takes with identical drum to cut the thick skin（0.6 mm）.Having taken the skin the donor area applies the vase line oil gauze to be covered.With alive check separately takes from drifts away the skin organization note fluid area and non-note fluid area each at the same place,sets at in the volume score 4% neutral cushion formaldehyde to be fixed.Results From heals in the number of days to observe in the different cover the group to heal quickly by ＂Z-S＂,nextis ＂L＂ the group,the slowest is ＂Z-Y＂ the group.＂Z-J＂ the group heals the outward appearance scar proliferation degree after the area and the patient private prosecution scratches with the finger itches,the ache degree obviously reduces.＂F＂ the group scar proliferation degree and the patient private prosecution scratch with the finger itches the ache degree to be lightest,the outward appearance approaches the normal skin.After takes in front of the skin the under-skin infusing fluid to cause outside the skin alignment to pass,are less or does not injury and the netted in-depth,is advantageous for obtains the thinner center thick skin,thus is advantageous to supplies the skin area to heal.Conclusion If the condition permit,Thick or thick center thick using allograft of taking off cell dermis compound with autograft of epidermis has the best clinical effect.Jie Ya surgical dressing with the body particle skin or biological surgical dressing A with the body particle skin to cover the donor skin area,the under-skin infusing fluid are helpful to the enhancement the heal quality for the donor skin area.