脱细胞真皮联合自体刃厚皮移植在特大面积烧伤后期瘢痕整复中的应用

Application of transplantation using acellular dermis and autologous epidermal skin graft to scar repair for late-stage extraordinarily large area burn

目的探讨异体脱细胞真皮加自体刃厚皮移植联合综合康复治疗在特大面积烧伤后期皮源奇缺患者瘢痕整复中的应用。方法选取18例特大面积烧伤后期皮源奇缺伴瘢痕增生、挛缩畸形患者,术前行压力、牵伸及关节松动等康复治疗,达平台期后行瘢痕切除松解、异体脱细胞真皮加自体刃厚皮移植修复创面,术后继续行关节松动、压力治疗、支具等综合康复治疗。结果 18例患者创面全部愈合,平均愈合时间13 d。术后早期介入康复治疗,随访6～12个月,创面皮片色泽、质地好,再挛缩轻,创面无复发,功能障碍改善明显,供皮区无瘢痕,可反复供皮。结论异体脱细胞真皮加自体刃厚皮移植联合综合康复治疗用于特大面积烧伤后期皮源奇缺伴瘢痕挛缩畸形的整复,可使受区皮片质地好,外观平整,挛缩轻,功能恢复良好,而且能使供区反复供皮,为皮源紧缺的患者创造多次整复的手术机会。

Objective To investigate the application of transplantation with allogeneic acellular dermis and autologous epidermal skin graft combined with comprehensive rehabilitation to scar repair in the patients with late-stage extraordinarily large area burn when skin source deficiency. Methods Eighteen late-stage extraordinarily large area burn patients complicated with hypertrophic scar,contracture and deformity were enrolled and suffered skin source deficiency. The patients received preoperative rehabilitation including pressure,stretching,and joint loosening. Wound repair was conducted by removal and release of scar,transplantation with allogeneic acellular dermis and autologous epidermal skin graft after plateau. Continuous comprehensive rehabilitation was conducted after operation,including joint mobilization,pressure therapy and braces. Results The wound was healed in all the 18 patients,and the average duration for healing was13 days. Early interventional rehabilitation was performed after operation. The duration of follow-up was6-12 months. The wound with good color and texture and mild recontracture was observed. No recurrence occurred in the wound. The dysfunction was significantly improved. No scars was found in the donor site,thus skin grafts could be obtained repeatedly. Conclusion For the repair of late-stage extraordinarily large area burn complicated with scar contracture and deformity under the condition of skin source deficiency,transplantation with allogeneic acellular dermis and autologous epidermal skin graft combined with comprehensive rehabilitation not only enables the skin of recipient site to obtain good texture,smooth appearance,mild contracture and improved function,but also enables the donor site to supply skin repeatedly,thus creating multiple opportunities of repair for the patients with deficiency of skin sources.