大面积深度烧伤应用混合皮肤嵌植与微粒皮移植的比较

Comparison between intermingled skin transplantation and microskin grafting in repairing massive deep burn

目的了解大面积深度烧伤后混合皮肤嵌植与微粒皮移植疗效的差异。方法回顾性总结笔者单位1992-2008年17年间收治的101例大面积深度烧伤患者临床资料。将患者分为混合嵌植组52例、微粒皮组49例，比较2组患者首次自体供皮面积、首次自体皮覆盖创面面积、首次自体皮移植成活率、自体皮理论扩展倍数、自体皮实际扩展倍数、自体供皮总面积，以及术后残余创面情况、大关节功能状况等。结果混合嵌植组、微粒皮组的首次自体供皮面积分别为（3.25±0.48）％、（3.01±0.21）％TBSA，首次自体皮覆盖创面面积分别为（30.4±3.6）％、（41.4±1.3）％TBSA，首次自体皮移植成活率分别为（99.9±1.9）％、（87.5±6.8）％，自体皮理论扩展倍数分别为（9.5±1.3）、（13.9±1.4）倍，自体皮实际扩展倍数分别为（9.5±1.3）、（12.0±1.5）倍，上述指标组间比较，差异均有统计学意义（P〈0.05）；混合嵌植组、微粒皮组自体供皮总面积分别为（14.2±1.9）％、（14.0±2.1）％TBSA，2组比较，差异无统计学意义（P〉0.05）。混合嵌植组、微粒皮组残余创面超过0.5％TBSA者分别有23例占44.2％、37例占75.5％；混合嵌植组大关节功能状况较好者34例占65.4％，微粒皮组18例占36.7％。结论微粒皮移植法自体皮扩展倍数明显大于混合嵌植法，能更充分利用有限皮源；混合嵌植法创面愈合质量和大关节功能恢复状况优于微粒皮移植法。

Objective To study difference in curative effect between intermingled skin transplantation （IT） and microskin grafting （MG） in repairing massive deep burn. Methods Clinical materials of 101 patients with massive deep burn hospitalized from 1992 to 2008 were retrospectively summarized. Pa-tients were divided into IT group （n =52） and MG group （n =49）. The size of initial donor site for autologous skin, the wound size initially covered with autologous skin, the survival rate of initial autologous skin grafting, the theoretical expansion multiple of the autologous skin, the actual expansion multiple of the autologous skin, the total size of donated autologous skin, the remained wound condition, and the function of large joint of patients in two groups were compared. Results In IT group and MG group, the size of initial donor site for autologous skin was respectively （3.25±0.48） % TBSA and （3.01±0.21） % TBSA, the wound size initially covered by autologous skin was respectively （30.4±3.6） % TBSA and （41.4±1.3） % TBSA, the survival rate of autologous skin grafting was respectively （99.9± 1.9） % and （87.5±6.8） % , the theoretical expansion multiple of the autologous skin was respectively 9.5±1.3 and 13.9±1.4, the actual expansion multiple of the autologous skin was respectively 9.5±1.3 and 12.0±1.5, the difference be- tween two figures of each index was statistically significant （ P 〈0.05）. There was no statistical significant difference between IT and MG group in respect of the total size of donated autologous skin [respectively （14.2±1.9） and （14.0±2.1）%TBSA, P 〉0.05]. There were 23 patients （44.2%） with residual wounds over 0.5% TBSA in IT group, and 37 cases （75.5%） in MG group. There were 34 patients （65.4%） with good function of large joints in IT group, and 18 cases （36.7%） in MG group. Conclusions Ex- pansion multiple of autologous skin after MG is obviously larger than that after IT, thus limited skin source can be fully used. The wound healing quality and the restoration of large joint function of patients treated with IT are better than those of patients treated with MG.