脱细胞异体真皮与自体瘢痕组织联合自体刃厚皮复合移植修复大面积烧伤后畸形的疗效比较

Comparative effectiveness of acellular allogeneic dermis and autologous scar tissue combined with autologous blast-thickened skin combined transplantation to repair the malformations after extensive burn

目的比较脱细胞异体真皮与自体瘢痕组织联合自体刃厚皮复合移植修复大面积烧伤后畸形的临床疗效。方法选择2010年1月至2015年6月新乡市第二人民医院收治的26例大面积烧伤后畸形患者为研究对象。按照移植修复方案将患者分为脱细胞异体真皮联合自体刃厚皮复合移植组(A组,n=12)和自体瘢痕组织联合自体刃厚皮复合移植组(B组,n=14)。术后3、6个月,观察2组患者创面愈合率、创面收缩率,采用温哥华瘢痕量表(VSS)评估创面修复情况;采用焦虑自评量表(SAS)及抑郁自评量表(SDS)评估2组患者术前及术后3、6个月心理状态。结果2组患者术后6个月创面愈合率、创面收缩率高于术后3个月(P<0.05)。术后6个月,B组患者创面愈合率高于A组(P<0.05),2组患者创面收缩率比较差异无统计学意义(P>0.05)。术后6个月,2组患者创面血管分布、厚度、柔软度评分低于术后3个月(P<0.05);2组患者创面色泽评分与术后3个月比较差异无统计学意义(P>0.05)。术后6个月,2组患者创面血管分布、厚度、柔软度、色泽评分比较差异无统计学意义(P>0.05)。术前,2组患者SAS、SDS评分比较差异无统计学意义(P>0.05)。术后3、6个月,2组患者SAS、SDS评分低于术前;且B组患者SAS、SDS评分低于A组(P<0.05)。A组和B组患者复合移植成活率分别为(91.0±2.1)%和(96.0±2.4)%;2组患者复合移植成活率比较差异无统计学意义(P>0.05)。结论自体瘢痕组织联合自体刃厚皮复合移植方案修复大面积烧伤后畸形,整体修复效果好,创面愈合率高,患者心理负担低。

Objective To compare the clinical effect of acellular allogeneic dermis and autologous scar tissue combined with autologous blast-thickened skin combined transplantation to repair the malformations after extensive burn.Methods Twenty-six patients with severe post-burn deformities admitted to the Second People′s Hospital of Xinxiang City from January 2010 to June 2015 were selected as subjects.The patients were divided into acellular allogeneic dermis combined with autologous bladed skin composite transplantation group(group A,n=12)and autologous scar tissue combined with autologous bladed skin composite transplantation group(group B,n=14)according to the transplantation repair plan.At 3,6 months after operation,the wound healing rate and the wound contraction rate were observed,the Vancouver scar scale was used to assess the condition of wound repair.The self-rating depression scale(SDS)and self-rating anxiety scale(SAS)were used to evaluate the psychological status of the patients in the two groups before operation and at 3,6 months after operation.Results The wound healing rate and wound contraction of patients in the two groups at six months after operation were higher than those at three months after operation(P<0.05).The wound healing rate of patients in the group A was higher than that in the group B at six months after operation(P<0.05).There was no significant difference in the wound contraction rate between the two groups at six months after operation(P>0.05).The scores of vascular distribution,thickness and softness in the two groups at six months after operation were lower than those at three months after operation(P<0.05).There was no significant difference in the color score of wound between that at six months after surgery and at three months after surgery in the two groups(P>0.05).There was no significant difference in the score of vascular distribution,thickness,softness and color of wound between the two groups at six months after operation(P>0.05).Before surgery,there was no significant difference in the scores of SAS and SDS between the two groups(P>0.05).The scores of SAS and SDS in the two groups at three and six months after operation were lower than those before operation(P<0.05),and the scores of SAS and SDS in the group B were lower than those in the group A(P<0.05).At six months after operation,the composite graft survival rate in the group A and group B was(91.0±2.1)%and(96.0±2.4)%,there was no significant difference in the composite graft survival rate between the two groups(P>0.05).Conclusion Autologous scar tissue combined with autologous thick-skinned composite transplantation scheme to repair the patients with large post-burn malformed area is effective with good overall effect,high wound healing rate and low psychological burden.