采用人工真皮修复大面积烧伤早期手部创面的疗效观察

Observation on effects of artificial dermis for repair of large area burn wounds of hand

目的:观察早期应用人工真皮修复大面积烧伤患者手部创面的效果。方法:选取2009年1月—2010年9月就诊于北京市右安门医院的大面积烧伤患者38例,采用随机分组方法分为两组。人工真皮组19例在早期修复手部创面手术中用人工真皮覆盖创面,2周后用自体刃厚皮片覆盖。对照组19例创面早期切痂、行自体微粒+异体皮移植,后期肉芽组织再行植皮手术。两组术后均行换药、抗感染、加强营养、维护脏器功能等综合治疗,创面愈合后进行功能锻炼。两组均随访0.5～1年,比较两组患者手部功能恢复和皮片挛缩情况。结果:人工真皮组19例38只手于第1次术后3周创面愈合。术后随访观察,术区愈合好,手部伸展、握拳功能良好,复合皮具备较好的弹性,且术区愈后色素及瘢痕轻。对照组1例人院后2周死于重度感染及多脏器功能衰竭,余18例36只手于术后1个月余创面封闭;术后随访观察,术区均有不同程度的瘢痕挛缩、掌指关节背伸畸形、手指间蹼状瘢痕增生,功能活动受限。结论:人工真皮更好地解决了早期无自体皮源时有效封闭创面的问题,是大面积烧伤早期修复手部创面、减轻创伤瘢痕的良好覆盖材料。

Objective：To observe the clinical effect of artificial dermis on early repair of burn wounds of hand. Methods. Thirty-eight burn patients who were admitted to the Youanmen Hospital from January 2009 to September 2010 were randomly divided into two groups with 19 cases in each group. The artificial dermis group received early repair operation with artificial dermis coverage first and then split-thickness autologous skin grafting after 2 weeks. The control group received early excision of eschar, auto-microskin and allogenic skin grafting, and autologous skin graft at the later stage. Patients in both groups were treated with dressing change, anti-infection therapy, nutrition and organ function support etc. after operation, and rehabilitation exercises were given after wound healed. Patients were followed-up for 0. 5--1 year to compare the function of hand and contraction of the wound between the two groups. Results：The wounds were healed in 38 hands of 19 cases in artificial dennis group 3 weeks after the operation. The follow-up observation showed that the healing was satisfactory, and the function of extension and making fist was good, with better elasticity of composite skin, with mild scarring and lighter colorization of skin. In the control group, 1 patient died of severe infection and multiple organ failure 2 weeks after admission, the wounds of 36 hands of 18 patients healed 1 month a/ter the operation. Follow-up observation showed that there was contraeture in dif- ferent levels of the scars, metacarpophalangeal joint dorsiflexion deformity, webbed fingers scar, and limitation of functional activity. Condusions：The artificial dermis can effectively cover the wound in cases with lack of auto-skin in the early stage of bum, and it is a better coverage material in repairing the hand surface in order to lessen scar formation of the wound in the early stage of an extensive burn.