注液肿胀法联合气动植皮机头部取皮移植的优势

Infusion tumescent technique combined with air dermatome is preponderant in harvesting scalp grafts

背景:既往头部取皮一般使用滚轴式取皮刀取皮,对操作者的经验要求较高,经验不足时易导致取皮过厚,取皮后影响患者头发生长,且所取皮片边缘呈明显锯齿状,皮片利用率及供皮区利用率均不高。目的:比较注液肿胀法联合气动植皮机与联合滚轴式取皮刀行头部取皮应用效果。方法:采用气动植皮机联合注液肿胀法行头部取皮的37例特重度烧伤患者为植皮机组,与采用滚轴式取皮刀联合注液肿胀法行头部取皮的38例特重度烧伤患者(滚轴刀组)临床资料进行比较,两组均行刃厚皮片移植(皮片厚度约0.3 mm)。统计分析两组取皮片时间、皮片大小、厚薄均匀及边缘整齐程度、供皮区愈合时间、移植皮片成活率。结果与结论:使用注液肿胀法后头部取皮易于操作,取皮中、取皮后出血明显减少。气动植皮机组取皮平均用时7.9 min,较滚轴刀组平均缩短3 min(P<0.05),所取皮片较大,边缘整齐,厚薄均匀,最大皮片达12 cm×5 cm,供皮区均一期愈合,平均愈合时间5.5 d,较滚轴刀组平均缩短2.2 d(P<0.05)。两组患者头部供皮区均一期愈合,未出现头皮感染、坏死、小灶瘢痕或脱发。结果表明,气动植皮机联合注液肿胀法是一种简单高效的头部取皮方法,对于大面积特重度烧伤患者具有显著优越性和重要临床应用价值。

BACKGROUND：Previously, a roling dermatome was often used to take skin tissues from the head, which demands a higher experience for an operator. Lack of experience easily leads to too thick skin tissues and impact hair growth in patients, and harvested skin tissues have a jagged edge that influences the enough utilization of harvested skin tissues and donor site. OBJECTIVE：To explore the clinical effects of air dermatome combined with infusion tumescent technique versus roling dermatome combined with infusion tumescent technique to take the skin from the head. METHODS： Clinical data from 37 patients with severe burn undergoing air dermatome combined with infusion tumescent technique （experimental group） and 38 patients with severe burn undergoing roling dermatome combined with infusion tumescent technique （control group） were compared. Both of the two groups underwent razor-thin graft （skin thickness was about 0.3 mm）. The time of harvesting skin grafts, skin size, whether the skin grafts had uniform thickness and clean edges, healing time of skin donor sites, and survival rate of skin grafts were statisticaly analyzed in the two groups. RESULTS AND CONCLUSION：Infusion tumescent technique made the operation easy. Intraoperative and postoperative bleeding was significantly reduced. The mean time for harvesting skin grafts was 7.9 minutes in the experimental group, which was 3 minutes shorter than that in the control group （P 〈 0.05）. In the experimental group, the skin grafts were larger with clean edges and uniform thickness, and the maximum graft was 12 cm×5 cm in size; al the donor sites were primarily healed, and the average healing time was 5.5 days, which was 2.2 days shorter than that in the control group （P 〈 0.05）. Al the donor sites in the two groups were primarily healed with no scalp infection, smal scars or hair loss. Results from this study show that the air dermatome combined with infusion tumescent technique is a simple and effective method for harvesting skin grafts from the head and it has the remarkable superiority and important clinical value in extremely severe burn patients.