微型皮片移植方法在大面积深度烧伤中的应用

The application of miniature skin grafting in extensive deep burns

临床医师使用外科方法清除失去活力的烧伤坏死组织,并迅速封闭广泛开放的创面,已成为现代大面积深度烧伤救治的常用方法,也是预防烧伤严重感染的根本措施。但在治疗时,突出的矛盾是患者自体皮源不足,希望用少量甚至极少量的自体皮肤移植修复大面积深度创面成为临床工作者不断探索的命题。在皮肤移植的发展史上,经历了点状植皮、邮票植皮、网状植皮、筛状植皮、自体微粒皮或皮浆和异体皮混合移植、Meek微型皮片移植乃至自体细胞培养复合移植等多种方法,这些方法在实际使用中各有其优缺点和局限性。其中,自体微粒皮移植、自体皮浆移植及Meek植皮术是当前大面积深度烧伤患者常用的微型皮片移植方法,基本上解决了大面积深度烧伤患者供皮面积小而植皮面积大的矛盾。自体微粒皮移植需要异体皮肤或异种皮肤作为载体覆盖才能完成,包括大张异体皮覆盖自体微粒皮移植和大张异种皮覆盖自体微粒皮移植。自体皮浆移植尽管操作简单方便,但对创面条件要求更高。自体微粒皮移植及自体皮浆移植这两种植皮技术作为特大面积深度烧伤患者的传统创面修复方法,尽管受诸多限制,目前应用仍较广泛。Meek植皮技术,以其独特的皮片扩张技术和机械化操作大大改变了传统的徒手操作方式,目前已成为修复大面积深度烧伤创面较为理想的方法。

The surgical operations,which are commonly used to remove the necrosis tissues of burning and seal the open burn wounds, have become a general method of treating large area deeply burned patients, as well as the basic way of preventing infection of burning. Faced with the problem of the shortage of healthy skin,we are continuously seeking for various ways to reduce the use of autogenous skin to treat large area deeply burned wounds. In the history of skin grafting, several different ways of point-like skin grafting have been used, such as punctate skin grafting, meshed skin grafting, micro-skin grafting,Meek skin grafting and so on. However, each way has both advantages and disadvantages in clinic. Currently, autologous skin plasma grafting, micro-skin grafting and Meek skin grafting are common ways to treat large area deeply burned patients, which basically solve the problem of lacking autologous skin. Micro-skin grafting needs autologous or allogeneic skin as a vector to cover the wounds,including large pieces of autologous skin and allogeneie skin micro-skin grafting. Though it is easy to operate, autologous skin plasma grafting needs more clean burn wounds. The two traditional treatments of micro-skin grafting and autologous skin plasma grafting are still widely used to repair severe burn wounds despite of some shortcomings. As for its special skin-expansion technology and mechanized operation, Meek skin grafting has greatly changed the traditional manual operation and has become the ideal operational way of treating large area deeply burned patients.