再论焦痂薄化术在烧伤再生疗法中的应用前景

Re-discussing the Prospective Application of Eschar Thinning Technique in Burn Regenerative Therapy

"烧伤再生疗法"的前身是"烧伤湿性医疗技术(MEBT/MEBO)",它由烧伤湿润暴露疗法(MEBT)和湿润烧伤膏(MEBO)组成,1991年被列入国家"十年百项"成果首批十项推广技术之一。为了加速创面坏死组织早期液化过程,附加了"耕耘疗法"等项技术,初步形成了具有中国特色的烧伤医疗体系。因为这种疗法能够激活自身成体细胞,使创面实现生理性愈合,又被称为"皮肤原位再生复原技术",目前已成为我国治疗烧伤的主体技术。为了总结"烧伤再生疗法"治疗深度烧伤的临床经验,探讨加速创面坏死组织液化和缩短再生修复过程的有效方法,作者复习了与之有关的文献。结果发现,耕耘疗法能促进深Ⅱ度深型创面坏死组织液化,使这些创面实现原位再生修复;用其处理Ⅲ度创面,焦痂液化期偏长,从而也延长了烧伤皮肤再生愈合过程。Ⅲ度创面若附以"焦痂薄化术"处理,可有效地缩短液化期,在MEBT/MEB()培植的肉芽组织上移植自体皮肤很容易成活。同时观察到愈合后的皮肤形态近似于正常,组织病理学检查到具有类似于真皮组织的结构。据此认为,"焦痂薄化术"在"烧伤再生疗法"中应用前景十分广阔。

Moist Exposed Burn Therapy/Moisl Exposed Burn Ointment （MEBT/MEBO） is the precursor to ＂Burn Regenerative Therapy＂, and is composed of Moist Exposed Burn Therapy （MEBT） and Moist Exposed Burn Ointment （MEBO） which was included in the first bateh of ten techniques in the ＇Ten Years, Hundred Techniques program in 1991 by the Ministry of Health of the People＇s Republic of China. The ＂skin incision and tension reliving＂ technique is combined with MEBT/MEBO in order to accelerate the early liquefaction of ,eerotic tissue. And initially a system of burn treatment with Chinese characteristics was formed on the basis of MEBT/MEBO. MEBT/MEBO is also called ＂In Situ Skin Regenerative Restoration Technique＂ because it can activate adult somatic cells and achieve physiological wound healing which has been the mainstream technique of burn treatment in China. The author reviewed related articles in order to summarize the experience of ＂burn regenerative therapy＂ in the treatment of deep burns and explore the effective approaches to accelerate necrotic tissue liquefaction and shorten the process of regenerative restoration. It was found that the ‘ skin incision and tension reliving＇ technique can be applied to promote the liquefaction of neerolic tissue on deep type of deep Ⅱ degree burns and thus in situ regenerative restoration can be achieved. But tire liquefaction stage anti the regenerative healing process of burnt skin is prolonged if the ＇ skin incision and tension reliving＇ technique is adopted ira the treatment of Ⅲ degree burns. The liquefaction stage can be effectively shortened in the treatment of Ⅲ degree burns if the ‘Eschar Thinning Technique＇ is combined with MEBT/MEBO. The autologous grafted skin slices can more easily survive on the granulation tissue that has been cultivated by MEBT/MEBO. The histopathological examination revealed that the dermis found in skin tissue treated with MEBT/MEBO had normal morphology. Thus, it is believed that the prospective application of ‘Eschar Thinning Technique＇ is promising in ＂Burn Regenerative Therapy＂.