复合皮移植修复烧伤功能部位创面疗效评价

EFFECTIVENESS EVALUATION OF COMPOSITE SKIN GRAFTS IN REPAIRING DEEP BURN WOUNDS IN FUNCTIONAL REGIONS

目的探讨脱细胞同种异体真皮与自体刃厚皮复合移植修复深度烧伤功能部位创面的疗效。方法 2002年6月-2008年12月,收治30例烧伤及瘢痕整形患者共42个创面。男25例,女5例;年龄3～52岁,中位年龄31岁。烧伤24例35个创面,其中深Ⅱ度23个创面,Ⅲ度12个创面;病程3～45 d,平均24 d。瘢痕整形6例7个创面;病程9～21 d,平均16 d。42个创面分别位于颈部2个,手部4个,前臂及肘部8个,肩部3个,腘窝6个,膝部4个,小腿及足踝部15个。彻底清创、削痂及切除瘢痕后,创面范围为10 cm×10 cm～30 cm×20 cm。采用一步法将脱细胞同种异体真皮与自体刃厚皮复合移植修复创面。结果术后27例39个(92.9%)创面复合皮移植完全成活;3例3个(7.1%)创面复合皮部分坏死,分别经换药和自体皮片移植术后愈合。患者均获随访,随访时间30～34个月,平均32个月。复合皮有轻度色素沉着,外观平整,质地柔软,弹性好,皮肤耐磨;复合皮无挛缩及瘢痕增生,功能部位活动正常。刃厚皮供皮区未见瘢痕增生。结论脱细胞同种异体真皮与自体刃厚皮复合移植修复功能部位深度烧伤及瘢痕整形创面,可获得良好外形及功能。

Objective To evaluate the long-term outcome of composite grafts of acellular dermal matrix（ADM） and autologous spl it-thickness skin in repairing deep burn wounds. Methods From Jun. 2002 to Dec. 2008, 30 burn patients （42 wound） were treated. There were 25 males and 5 females, aged from 3 to 52 years with a median age of 31 years. Of them, 24 burned patients had 35 wounds, including 23 deep second degree and 12 third degree wounds with a mean course of 24 days （3- 45 days）; 6 patients with hyperthopic scar had 7 wounds with a mean course of 16 days （9-21 days）. The wound locations were neck （1 wound）, hand （4 wounds）, forearm and elbow （4 wounds）, shoulder （3 wounds）, poples （3 wounds）, laps （2 wounds）, ankle and legs （11 wounds）, and the area of wounds ranged from 5 cm × 8 cm to 20 cm × 30 cm. After thorough debridement, tangential excision and scar excision, acellular dermal matrix and autologous spl it-thickness skin graft was used to repair the wounds by. one step method. Results After operation, composite skin graft survived completely in 39 wounds of 27 patients, with a survival rate of 92.9%; partial necrosis occurred in 3 wounds of 3 patients, and healed after dressing change and secondary skin graft. The patients were followed for 30-34 months postoperatively （mean, 32 months）. The appearance of the composite grafts was smooth and soft with good elasticity and low pigmentation. The activity and function of l imbs recovered well . No scar hyperplasia was observed at the donor sites. Conclusion It can achieve good outcomes in appearance and function to use acellular dermal matrix and autologous spl it-thickness skin graft for repairing deep burn wounds in functional regions.