中厚皮移植修复深Ⅱ度烧伤瘢痕畸形的疗效分析及护理策略探讨

The Analysis of the Curative Effect and Nursing Strategy of Repairing the Scar Deformity of Deep Second Degree Burn with Medium Thick Skin Transplantation

目的:分析中厚皮移植在深Ⅱ度烧伤瘢痕畸形整复中的疗效,并总结围术期护理体会。方法:回顾性分析2017年1月-2018年12月68例(86个关节)深Ⅱ度烧伤瘢痕畸形整复患者临床资料,所有患者给予瘢痕切除+中厚皮移植整形+功能锻炼,记录患者术后各关节创面植皮存活率及其术前、术后1个月、3个月、6个月、12个月瘢痕情况[温哥华瘢痕量表(Vancouver scar scale,VSS)进行评定],统计术后6个月、12个月关节功能恢复效果,总体评价术后12个月临床疗效。结果:68例患者86个关节创面植皮存活率为92.5%~100.0%,平均(96.86±3.25)%;患者术后1个月、3个月、6个月、12个月VSS评分均呈下降趋势,且均显著低于术前(P<0.05);术后6个月、术后12个月关节功能恢复优良率达93.02%、98.84%;术后12个月治疗总有效率达100.00%。结论:中厚皮移植整形术用于深Ⅱ度烧伤瘢痕畸形整复患者,能有效促进术后恢复、改善患者关节功能,具有较好的远期疗效,且有效的围术期护理在保障植皮存活、促进患者恢复等方面具有重要意义。

Objective To analyze the efficacy of medium thick skin transplantation on patients with scar deformity after deep second degree burns,and summarize the perioperative nursing experience.Methods The clinical data of 68 patients(86 joints)with scar deformity after deep second degree burns from January 2017 to December 2018 were retrospectively analyzed,and all the patients were given scar resection+medium thick skin transplantation+functional exercise.The survival rate of joint wound grafts after surgery was recorded among patients.The scar condition(Vancouver scar scale,VSS)in the two groups was compared before surgery and at 1 month,3 months,6 months and 12 months after surgery.The joint function recovery effects were counted at 6 months after surgery and at 12 months after surgery,and the clinical efficacy at 12 months after surgery was evaluated.Results The survival rate of wound grafts of 86 joints among 68 patients was 92.5%-100.0%,with an average of(96.86±3.25)%.The VSS scores among patients showed a downward trend at 1 month,3 months,6 months and 12 months after surgery,and all were significantly lower than that before surgery(P<0.05).The excellent and good rate of joint function recovery was 93.02%at 6 months after surgery and was 98.84%at 12 months after surgery.And the total effective rate was up to 100.00%at 12 months after surgery.Conclusion Medium thick skin transplantation for patients with scar deformity after deep second degree burns can effectively promote scar surface recovery and improve joint function,and it has good long-term efficacy.Effective perioperative nursing is of important significance in ensuring skin graft survival and promoting patient recovery.