自体与异体活体小皮片混合移植治疗大面积深度烧伤的临床研究

Clinical study on extensive deep burn patients treated with intermingled transplantation of small stamps of auto-alloskin

目的探讨自体与异体活体小皮片混合移植覆盖大面积深度烧伤创面的可行性。方法对9例特大面积深度烧伤患者的大面积肉芽创面,采用自体与异体活体小皮片混合移植法覆盖,自体与异体皮比例为1:1,自体和异体取皮面积与覆盖肉芽创面面积均为1:2～3,植皮创面常规包扎、换药,疗程中不应用免疫抑制剂或其他抗排斥药物。术后坚持随访,观察创面愈合情况。结果本组9例,均在伤后3周后行肉芽创面自、异体小皮片混合移植术。最大覆盖肉芽创面面积为70%,最小为12%。术后3d,自、异体皮片存活良好,术后7～10d,创面基本愈合。最长随访2年10个月,最短随访5个月,愈合过程中及愈合后均未见明显的异体皮被排斥而出现创面裸露等现象。结论自体与异体小皮片按一定比例混合移植,可作为治疗大面积深度烧伤创面的一种覆盖方法。混合移植的自、异体皮比例及移植后的异体皮成活和局部免疫耐受机制,有待进一步研究。

Objective To explore the possibility of treating the extensivedeep burn patients with intermingled transplantation of small stamps of auto-alloskin.Methods Grafted the large areas of granulation wounds with intermingled transplantation of small stamps of auto-alloskin in nine cases suffering from massive deep burns in themetaphase and telophase of treatment.The ratio of auto-alloskin was 1：1 and the graft areas were 2-3 times to donors.The operation method and the dressing change of the grafting wounds were all according to general rules.No immunosuppressive or anti-rejection agents were used in the stage of treatment.Results Among the nine cases,this intermingled skin grafting was performed one time in four cases,two times in four cases and three times in one case.The maximal area of mixed grafting was 70%TBSA and the minimum was 12% TBSA.Thesurvival rate of the mixed skin grafts was above 95% after 3 d of theoperation and the wound healed 7-10 d after this mixed grafting.The rejection of the alloskin did not occur during the healing process and after the longest follow-up of thirty-four months and the minimum follow-up of five months.Conclusion Intermingled transplantation of small stamps of auto-alloskin may be a atternative method for treating the extensive deep burn wounds.