持续负压吸引联合人工真皮支架、刃厚头皮移植在治疗颈部瘢痕挛缩中的应用

Application of continuous negative pressure suction combined with artificial dermis scaffolds and scalp transplantation in improving scar contracture of major burns

目的探讨持续负压吸引(continuous negative pressure aspiration,VSD)联合人工真皮支架、刃厚头皮移植在改善大面积烧伤颈部瘢痕挛缩中的应用价值。方法选择2013-6至2017-12武警特色医学中心烧伤整形科收治大面积烧伤后颈部瘢痕挛缩畸形且使用持续负压吸引联合人工真皮支架、刃厚头皮移植的患者42例作为观察组,随机抽取同期采用颈部瘢痕松解后直接移植中厚皮的36例患者作为对照组。结果两组患者颈部瘢痕松解后均能达到满意效果;观察组创面愈合时间平均为(17. 48±1. 52) d,对照组创面愈合时间平均为(13. 36±2. 06) d,观察组创面愈合后颈部后仰下颌角与颈部纵轴角度平均为135°±3. 24°,左右旋转角度平均达150°±4. 34°,而对照组患者创面愈合后颈部后仰下颌角与颈部纵轴角度平均为133°±3. 62°,左右旋转角度平均达147°±3. 28°,两组治疗后患者颈部瘢痕挛缩畸形得以改善,颈部功能得以改善,两组比较差异无统计学意义(P> 0. 05)。结论持续负压吸引联合人工真皮支架、刃厚头皮移植在改善大面积烧伤颈部瘢痕挛缩方面具有良好的效果。

Objective To explore the applicability of continuous negative pressure suction combined with artificial dermal scaffolds and scalp transplantation in the treatment of large-area burn scar contracture.Methods Between June 2013 and December 2017, 42 cases of cervical scar contracture deformity after large area burn were treated with continuous negative pressure suction combined with artificial dermal scaffolds and scalp transplantation (the observation group), while another 36 cases of direct transplant of the moderately thick skin after cervical scarring were randomly selected as the control group.Results The average healing time of the wounds in the observation group was (17.48±1.52) days, compared to (13.36±2.06) days in the control group. After wound healing, the average value of cervical retro-mandibular angles and cervical longitudinal axis in the observation group was (135±3.24)°,compared with (150±4.34)°and (133±3.62)°in the control group. Neck function was improved in both groups, the skin graft of the neck was good in color and elasticity, and scar contracture was inhibited. The function of the neck scar was improved by either treatment. No significant difference was observed between the observation group and the control group.Conclusions Continuous negative pressure suction combined with artificial dermal scaffolds and scalp transplantation can improve the scar contracture of large-area burns.