儿童车祸伤创面复合植皮治疗的长期疗效观察

Long term curative effects of composite graft on children's cutaneous deficiency wounds caused by road accident

目的:观察脱细胞同种异体真皮与自体刃厚皮复合植皮封闭儿童车祸伤创面后长期疗效情况。方法:车祸后下肢皮肤软组织坏死病例60例,随机分为2组。治疗组30例,坏死皮肤软组织一期予以清除并植入脱细胞同种异体真皮,3周后植入大张自体刃厚皮片。对照组30例,坏死皮肤软组织一期予以清除,创面换药,肉芽红润后予以植入大张自体刃厚皮片。创面完全封闭后出院。术后1、3、6月、1年、以后每年1次随访,最长随访至5年,观察创面愈合后外形、色泽、弹性。B超测量真皮厚度、硬度计测定硬度。结果:早期随访:治疗组术区较饱满、瘢痕轻、瘢痕无破溃及水泡;对照组术区瘢痕较重,有破溃及水泡。5年随访:治疗组术区色泽接近正常皮肤、局部较饱满、光滑、柔软、瘢痕轻且平整、弹性好,B超测量其真皮厚度低于对照组(P=0.000),超过正常皮肤组(P=0.000),真皮回声接近正常真皮,硬度接近正常皮肤;对照组术区凹陷、瘢痕重、质硬、弹性差,其真皮厚度及硬度均超过治疗组及正常皮肤(P=0.000),B超显示真皮回声明显杂乱,增强。结论:脱细胞同种异体真皮与自体刃厚皮复合植皮封闭儿童车祸伤创面长期随访,局部效果明显优于单一刃厚植皮,明显改善了愈合后皮肤质量,有较好的临床应用价值。

Objective：To investigate long term curative effects of composite graft of acellular allogenic dermal matrix and razor thin autoskin on children＇s cutaneous deficiency wounds caused by road accident. Methods：Totally 60 children with cutaneous deficiency wounds caused by road accident were enrolled and were divided into two groups randomly and equally. In treatment group（n=30） ：cu- taneous deficiency wounds were debrided and grafted with acellular allogenic dermal matrix;after 3 weeks,wounds were grafted with razor thin autoskin. In control group（n=30）：cutaneous deficiency wounds were debrided and grafted with razor thin autoskin. The wounds were followed-up for 1 month, 3 months, 6 months, lyear and every year until the 5th year after the operation to investigate their appearance ,color and elasticity. Dermis thickness and hardness were measured respectively by SEQULAS12 color ultrasono- graph and hardness machine. Results ： Follow-up at earlier stage： compared with that in control group, appearance of the operated area in treatment group was well-stacked with lighter scar and no scar breakage and bubble. Five-year follow-up：color of the operated area in treatment group was similar to that of normal skin. Appearance of the operated area in treatment group was well-stacked, smooth and soft with light scar and good elasticity. According to the results of uhrasonograph, thickness of dermis was lower in treat- ment group than in control group（P=0.000）,lower in normal skin group than in treatment group（P=0.000）. Dermal echo and hard- ness in treatment group were close to those of normal skin. Appearance of the operated area in control group was serious sagged with heavy and hard scar and poor elasticity. Thickness and hardness of dermis were both exceeded those in treatment and normal skin groups（P=0.000）. Uhrasonograph showed dermal echo in control group was obvious mixed and disorderly enhanced. Conclusions： Long term curative effect of composite graft of acellular allogenic dermal matrix and razor thin autoskin on children＇ s cutaneous defi- ciency wounds is better than that of only razor thin autoskin graft,which can improve healing quality of skin and has fine clinical value.