Meek植皮加悬浮床封闭大面积深度烧伤创面的效果观察

Combination of Meek skin grafting and suspension bed in closure of large area deep burn wound-surface:Efficacy observation

目的临床观察Meek植皮结合悬浮床对烧伤患者创面封闭的疗效。方法通过笔者所在医院2010年9月—2015年9月应用Meek植皮结合悬浮床,治疗51例深度烧伤皮源稀缺患者,观察术区皮片成活、创面愈合时间、愈合后外观及功能,以及供皮区愈合情况。结果 51例患者中,2例因故放弃治疗;1例泛耐药铜绿假单胞菌全身感染死亡;1例金黄色葡萄球菌创面感染,术后18 d愈合;1例薄纱下有凝血块,术后17 d愈合;其余46例Meek植皮结合悬浮床治疗,术后5 d皮片开始扩展,1∶4和1∶6愈合天数分别是10~12 d,13~15 d,后期瘢痕平整均匀,有一定弹性,关节活动可;供皮区愈合时间:头部6~8 d、躯干和臀部12~15 d、四肢13~16 d,头部间断取皮达10次以上,其他取皮3~4次。结论 Meek植皮+悬浮床治疗可使术区和供皮区免受压、利于创面干燥、不适宜致病菌生长、营养物质丢失少、皮片成活概率高、血液循环加快,皮片向周边扩展快且一致,病程短,后期以软平性瘢痕为主,且供皮区因不受压,愈合快,同部位反复取皮间隔时间短,节约皮源并缩短病程,为大面积深度烧伤患者治疗,提供较可靠的封闭创面可能性。

Objective To observe curative effect in .the patients with burns of their wound-surface closed by Meek skin graft technology combined with suspension bed. Methods In the author＇s unit between September 2010 and September 2010,suspension bed application technology combined with Meek graft was used in treatment of 51 patients with deep burn of the incidence scarce. After operation skin flap survival,wound healing time,the healed appearance and function,and the healing status of skin area were observed. Results Among 51 cases 2 were gave up treatment;1 died of generic drug resistant pseudomonas aeruginosa systemic infection;l case infected from staphylococcus accrens on the wound-surface,but at 18 days after surgery cured;1 case had blood clotting mass under thin gauze,but at 17 days after surgery wound was healing;rest received above combination,then,skin begun to extend five days after the surgery,for 1：4 and 1：6 healing days were 10 to 12 days,and 13 to 15 days; Scar formation was uniform,had certain elasticity,joints were fairy;For the skin area healing time：6-8 days in head,in torso and hips,12-15 days,in limb 13-16 days;for head leather reached more than 10 times,the other site for leather 3-4 times. Conclusion Because the operation area and the donor site are free of compression benefit to dry wound,and bad to pathogenic bacteria growth,less nutrient Ioss,just flap survival obtain high probability,blood circulation speeds up,skin extend is fasting to the surrounding so that up to consistent,disease courses become short;in the late soft flat scar predominated ,and the donor site is free of compression,its healing is quickly,for same position leather interval time is short saving the incidence rate and shorten the course of the disease,generally,for the patients with large area deep burn treatment can be provided more reliable possibility of closed wound-surface.