覆盖肉芽创面自体微粒皮移植术修复大面积深度烧伤创面的临床效果

The clinical effect of micro-skin autograft covering granulation wounds in repairing large-area deep burn wounds

目的探讨覆盖肉芽创面自体微粒皮移植术修复大面积深度烧伤创面的临床效果。方法我院122例行自体微粒皮移植术治疗的大面积深度烧伤患者,其中58例行传统自体微粒皮移植术(对照组),64例行覆盖肉芽创面自体微粒皮移植术治疗(观察组),比较两组术后恢复情况(二次植皮手术率、首次术后创面Ⅰ期愈合率、创面愈合时间、住院时间)及脓毒症、多器官功能障碍综合征(MODS)发生情况,比较出院时及术后3、6个月创面瘢痕情况[温哥华瘢痕量表(VSS)、患者瘢痕评价量表(PSAS)]及日常活动能力[改良Barthel指数(MBI)]。结果观察组二次植皮手术率、创面愈合时间、住院时间、脓毒症及MODS发生率均低于对照组,首次术后创面Ⅰ期愈合率高于对照组(P<0.05)。两组术后创面VSS、PSAS评分均逐步降低,出院时及术后3、6个月,观察组创面VSS、PSAS评分均低于对照组(P<0.05)。两组术后MBI评分均逐步升高,出院时,观察组MBI评分高于对照组(P<0.05);两组术后3、6个月MBI评分比较,差异无统计学意义(P>0.05)。结论覆盖肉芽创面自体微粒皮移植术修复大面积深度烧伤创面效果显著,安全性较高,具有良好应用前景。

Objective To explore the clinical effect of micro-skin autograft covering granulation wounds in repairing large-area deep burn wounds.Methods Clinical data of 122 patients with large-area deep burns who underwent micro-skin autograft in our hospital were retrospectively analyzed.Among the patients,58 patients underwent traditional micro-skin autograft(control group)and 64 patients were given micro-skin autograft covering granulation wounds(observation group).The postoperative recovery status(secondary skin graft rate,first postoperative wound stage I healing rate,wound healing time and hospital stay)and occurrence of sepsis and multiple organ dysfunction syndrome(MODS)were recorded in the two groups.The wound scar condition estimated by using Vancouver Scar Scale(VSS)and Patient Scar Assessment Scale(PSAS)and daily activity ability estimated by using Modified Barthel Index(MBI)were compared at discharge and after 3 and 6 months of surgery.Results The secondary skin graft rate,wound healing time,hospital stay and incidence rates of sepsis and MODS in the observation group were lower than those in the control group(P<0.05)while the first postoperative wound stage I healing rate was higher than that in control group(P<0.05).The scores of wound VSS and PSAS in the two groups after surgery were decreased with time(P<0.05).At discharge and after 3 and 6 months of surgery,the scores of wound VSS and PSAS of the observation group were lower than those of the control group(P<0.05).The MBI score of the two groups after surgery was increased with time(P<0.05).At discharge,the MBI score of the observation group was higher than that of the control group(P<0.05).There were no statistically significant differences in the MBI scores between the two groups after 3 and 6 months of surgery(P>0.05).Conclusion Micro-skin autograft covering granulation wounds has a significant effect and high safety in repairing large-area deep burn wounds.It has good application prospects.