面部烧伤后肉芽创面移植大张中厚皮临床体会

Clinical Experience of Large Medium-thick Skin Grafting for Granulation Wound after Facial Burns

目的探讨面部烧伤后肉芽创面移植自体大张中厚皮的可行性。方法回顾性分析2002年1月-2012年4月收治的27例面部烧伤后肉芽创面进行自体大张中厚皮移植手术患者的临床资料。术中用手术刀刮除肉芽组织至基底层,用取皮鼓或电动取皮刀取患者大腿或者腹部大张中厚皮,移植于受皮区,术后5 d左右打开敷料半暴露或暴露。结果 27例手术患者中24例大张中厚皮全部成活,3例大部分成活,再次补植皮后愈合。患者创面愈合后外形丰满,皮肤弹性较好,表情丰富。20例随访1～5年,患者面部外观良好,2例发生小口畸形,2例眼睑轻中度外翻,分别行整形手术后改善。结论面部烧伤后肉芽创面移植大张中厚皮可获得较满意的治疗效果,可在临床推广使用。

Objective To investigate the feasibility of large medium-thick skin grafting for facial post-burn granulation wounds.Methods We retrospectively analyzed the clinical data of 27 patients with post-burn granulation wounds undergoing large medium-thick skin grafting between January 2002 and April 2012.During the surgery,scalpel was used for curettage of granulation tissue to the basal layer,and a drum or motor dermatome was used to take large medium-thick skin grafts from patients＇ thigh or abdomen for transplantation.Five days after the surgery,the dressing was opened to half or full exposure.Results Large medium-thick skin in 24 of the 27 patients survived,and 3 had a large proportion of survival which was cured by skin grafting again.Patients recovered well with good skin elasticity and full expression.Twenty patients were followed up for one to five years.There were two cases of microstomia and another two of eyelid mild-to-moderate hallux valgus,and their situation was improved after plastic operation.Conclusion The facial post-burn granulation wound transplantation with large medium-thick skin can obtain more satisfactory curative effect in clinical use.