实用新型皮肤牵拉器的临床应用

Clinical application of a new skin-stretching device

背景:以往的皮肤外扩张装置修复深度创面或皮肤缺损存在瘢痕增生明显、需多次手术、患者痛苦大及费用高等不足。目的:观察自行设计皮肤牵拉器(专利号:ZL 2012 2 0022443.7)治疗深度创面的临床效果。方法:纳入30例深度烧伤创面、皮肤缺损或条索状瘢痕患者,其中男22例,女8例,年龄18-49岁,均采用皮肤牵拉器进行皮肤牵引治疗,随机分为2组,其中20例从1 kg拉力开始牵引,每2 d增加1 kg,直至5 kg,每日牵拉6 h,共牵拉10 d,检测牵拉即刻、牵拉1,5,10,15,20,30及60 min时皮肤的血流量,并观察创缘皮肤改变,观察牵拉结束后的皮肤组织学变化;另10例中,2例、6例、2例分别以2,4,7 kg拉力进行皮肤牵引,观察皮肤血流量及皮肤改变等情况,寻找出最合适、安全的拉力。结果与结论:30例均一期愈合,愈合时间8-24 d,随访见外观与功能恢复良好,无皮肤坏死、感染及末梢循环障碍。皮肤牵拉器在4 kg拉力作用下最安全、合适,不会出现皮肤血循环障碍或撕裂。牵引后,皮肤血流增加,细胞数增多,以基底细胞数目增多明显,胶原纤维粗而密,弹力纤维明显增加,成纤维细胞和毛细血管密度增加。说明应用自行设计的皮肤牵拉器进行皮肤牵引,可以较好地闭合创面,减少瘢痕形成。

BACKGROUND： Previously deep burn wound or skin defects are generally repaired with skin grafting or flap of skin grafting. Obvious scar hyperplasia usually appears after operation,which requires multiple surgeries. Meanwhile,patients have to suffer from great pain and bear high cost. OBJECTIVE： To observe the clinical effects on deep wounds by continuous traction of self-designed skin-stretching device（patent No. ZL 2012 2 0022443.7）. METHODS： Thirty patients with deep burn wound,skin defect or funicular scar were enrolled,including 22 males and 8 females,aged 18-49 years,and randomly divided into two groups. Skin-stretching device was adopted for skin traction treatment. Twenty cases underwent skin traction from 1 kg pulling force to 5 kg,with an increase of 1 kg per 2 days,6 hours a day for 10 days. Blood flow at the beginning,1,5,10,15,20,30,60 minutes of the skin traction,and the changes of wound edge skin as well as histological changes of the skin were observed. Of the remaining 10 cases,2,6,and 2 cases underwent skin traction of 2,4,7 kg,respectively. Blood flow and skin changes were also observed to find out the most suitable and safe force. RESULTS AND CONLUSION： All the 30 cases achieved primary healing without necrosis of skin,infection or peripheral circulatory disorders,and the appearance and function recovered well. The healing time was 8-24 days. The skin-stretching device was most safe under 4 kg pulling force,by which,there was neither blood circulation obstacle nor tear of skin. After traction,the skin blood flow and the number of cells increased,especially the epithelial basal cells. The collagen fibers became thicker and denser,and the elastic fibers regeneratedsignificantly; the fibroblasts and capillary density increased. It has been proved that we can better close the wound and reduce scar formation effectively with the self-designed skin-stretching device for skin traction.