38例先天性皮肤缺损创面不同治疗方法的疗效分析

Curative effect of different treatment methods for 38 patients with congenital skin defect wounds

目的探讨先天性皮肤缺损的创面处理方法。方法 38例先天性皮肤缺损创面,18例10%以下创面保守治疗(其中13例去膜,5例膜全)、1例7%的创面保守+大张刃厚植皮治疗、16例10%以上创面大张刃厚植皮治疗、3例伴骨缺损创面人工真皮+大张刃厚植皮治疗,总结不同缺损程度及不同处理方法的长期随访结果。结果本组38例均恢复良好。7例出院后失访。31例随访5个月至7年不等。14例(包括部分保守、部分手术病例)保守治疗创面,5例未去膜创面愈合较去膜创面快,且3例愈合后仅遗留色素减褪,2例遗留平、软、色素减褪浅表瘢痕,去膜的9例创面愈合后均遗留轻重不等瘢痕伴色素减褪。15例(包括部分保守、部分手术病例)刃厚植皮治疗创面愈合后5例无明显瘢痕,5例遗留平、软羊皮纸样瘢痕,5例遗留轻重不等增生性瘢痕;3例人工真皮+刃厚植皮的头皮缺损+颅骨缺损创面均遗留平、软、与皮肤同色瘢痕伴秃发,其深部颅骨缺损均已痊愈。结论先天性皮肤缺损创面覆盖膜为发育不良表皮,有促进创面愈合作用;10%以下创面保守治疗能达到理想创面愈合效果,但处理中需完整保留其表面覆盖的膜;10%以上创面由于愈合时间较长为避免并发症发生建议大张刃厚植皮封闭;伴颅骨缺损创面不需处理骨缺损。

Objective To explore the treatment methods for the wounds of congenital skin defect.Methods In 38 patients with congenital skin defect,18 patients with wound area less than 10% were bandaged and dressing changed（membrane was removed in 13 patients and remained in 5 patients）,1 patient with wound area of 7% was bandaged,dressing changed and grafted with big piece razor thin autoskin,16 patients with wound area more than 10% were grafted of big piece razor thin autoskin,and 3 patients complicated with skull defects were grafted with artificial dermis and big piece razor thin autoskin.A long-term follow-up was carried out,and the curative effects of the three treatment methods were summarized.Results All of the 38 patients got favorable recovery,and 31 patients were followed up for 5 months to 7 years.The wound healing of the 5 patients who were bandaged and dressing changed with membrane were quicker than that of those without membrane.Three patients had pigment dimmed but no obvious scars,and 2 patients had light scars.The 9 patients without membrane all had different degrees of scars with dimmed pigment.In the 15 patients receiving big piece razor thin autoskin grafting,5 patients had no scars,5 patients had light scar,and 5 patients had different degree of hyperplastic scars.The 3 patients complicated with skull defects treated by artificial dermis and big piece razor thin autoskin grafting all had light scars with no hair,but the skull defects were cured.Conclusion Membranes of wounds were epidermis of maldevelopment and can promote wound healing.Wound area less than 10% leads to good efficacy by bandaged and dressing changed with membrane,while wound area more than 10% suggests big piece razor thin autoskin grafting to avoid severe complication.In wounds complicated with skull defects,skull defects need not to be treated.