人工真皮联合自体刃厚头皮在修复儿童烧伤后肢体关节瘢痕挛缩中的临床应用效果

Clinical application effect of artificial dermis combined with autologous blade thick scalp in repairing limb joint scar contracture after burn in children

目的探讨人工真皮联合自体刃厚头皮在修复儿童烧伤后肢体关节瘢痕挛缩中的临床应用效果。方法回顾性分析2017年3月至2020年3月北京丰台右安门医院烧伤整形科收治的儿童肢体关节部位烧伤后瘢痕挛缩23例。患儿于入院后完善术前常规化验及检查,一期手术切除瘢痕组织,矫正关节挛缩畸形,取与创面面积相同大小的人工真皮打孔并覆盖创面,采用含银抗菌敷料、纱垫、医用棉垫等适当加压包扎,石膏固定关节部位;围手术期予以抗生素预防感染;术后1周开始换药观察人工真皮血管化情况,2~3 d换药1次。术后2周人工真皮血管化,创基见类真皮组织,行二期手术取相同与创面大小刃厚头皮(厚度约0.2~0.3 mm)移植于创面,钉皮钉固定,用含银抗菌敷料、纱垫、医用棉垫等适当加压包扎供受区;植皮术后受区3 d开始换药,2~3 d换药1次;供皮区于术后5 d去除外层敷料,保留内层油性含银敷料,保持干燥待自然脱落愈合。术后观察人工真皮血管化和刃厚头皮存活情况,门诊或网络随访远期观察植皮区有无破溃、色泽、质地、瘢痕生长情况及关节功能。结果一期手术后除2例患儿因血肿或感染并发症致人工真皮脱落或溶解,经二次清创后再次覆盖人工真皮成功血管化外,其余21例均一次手术实现人工真皮血管化。二期手术植皮后,移植的23例刃厚头皮均存活;门诊或网络随访6~12个月,移植皮片未见破溃,色泽、质地均良好,无瘢痕增生,关节功能恢复满意。结论人工真皮联合自体刃厚头皮修复儿童烧伤后肢体关节瘢痕挛缩较皮瓣或全厚皮片修复创伤更小,疗效满意。

Objective To investigate the clinical application effect of artificial dermis combined with autologous blade thick scalp in repairing limb joint scar contracture after burn in children.Methods A retrospective study was conducted on 23 children with scar contracture after burn in the joint of the limbs in Department of Burns and Plastic Surgery,Beijing Fengtai Youanmen Hospital from March 2017 to March 2020.Routine preoperative laboratory tests and examinations were completed after the patients were admitted to hospital.Scar tissue was removed in the first stage of surgery to correct joint contracture deformity.Artificial dermis of the same size as the wound area were taken to perforate and cover the wound,and the silver-containing antibacterial dressings,gauze pads,medical cotton pads,etc.were used to properly pressurize and plaster to fix the joints.Antibiotics were given to prevent infection during perioperative period.Dressing change was started 1 week after operation to observe the vascularization of the artificial dermis,and the dressing was changed once every 2 to 3 days.Two weeks after the operation,the artificial dermis was vascularized,and dermal tissue was found in the wound base.The second-stage operation was performed to transplant the blade thick scalp of the same size as the wound(thickness about 0.2-0.3 mm)onto the wound,fixed it with skin nails,and bandaged the donor and recipient areas with silver-containing antibacterial dressings,gauze pads,medical cotton pads,etc.The dressing was changed at the receiving area 3 days after skin grafting,and the dressing was changed once every 2 to 3 days;the outer dressing was removed from the donor area 5 days after the operation,and the inner oily silver dressing was retained,and kept dry until it fell off and healed naturally.The vascularization of the artificial dermis and the survival of the razor-edge thick scalp were observed after surgery.The outpatient or network follow-up was performed to observe the rupture,color,texture,scar growth and joint function of the grafted skin area in the long term.Results After the first operation,the artificial dermis was vascularized in all the other 21 cases,except 2 cases which were successfully vascularized by covering the artificial dermis again after the second debridement due to the loss or dissolution of the artificial dermis due to hematoma or infection complications.After the second stage of skin grafting,all the 23 patients with blade thick scalp survived.After 6 to 12 months of outpatient or network follow-up,the grafts showed no rupture,good color and texture,no scar hyperplasia,and satisfactory recovery of joint function.Conclusion Artificial dermis combined with autologous blade thick scalp to repair limb joint scar contracture after burn in children is less traumatic than skin flaps or full-thickness skins,and the effect is satisfactory.