人工真皮联合自体瘢痕表皮移植修复大面积烧伤后期关节部位瘢痕畸形

Artificial dermis combined with autologous scar epidermis composite transplantation in repair of joint site scar deformities in the later stage of extensive burns

背景:如何既为大面积深度烧伤患者瘢痕整形修复提供足够的皮源,又能避免术区创面瘢痕的再次增生,一直是烧伤与创面修复研究的重要课题。目的:观察人工真皮联合自体瘢痕表皮复合移植在大面积烧伤后瘢痕整复中的临床应用效果。方法:回顾性分析2021年1月至2023年1月在蚌埠医学院附属蚌埠第三人民医院接受手术治疗的大面积烧伤后瘢痕增生、挛缩畸形患者的病历资料,共纳入73例,按照治疗方法分为3组:A组(n=21)接受人工真皮联合自体瘢痕表皮移植治疗;B组(n=27)接受功能部位瘢痕松解后移植自体瘢痕表皮治疗;C组(n=25)接受功能部位瘢痕松解后移植自体中厚皮治疗。记录3组患者受皮区皮片存活及感染情况,受皮区及供皮区创面愈合时间;通过温哥华瘢痕量表(VSS)、日常生活活动能力(ADL)评定3组患者受皮区、供皮区瘢痕情况及受皮区功能恢复情况。结果与结论:①B组患者皮片感染率低于A、C组(P<0.05),皮片存活优级率高于A、C组(P<0.05);②A组患者受皮区创面完全愈合时间长于B、C组(P<0.05),C组患者受皮区创面完全愈合时间长于B组(P<0.05);C组患者供皮区完全愈合时间长于A、B组(P<0.05);③B组患者术后12个月受皮区温哥华瘢痕量表评分高于A、C组(P<0.05),C组患者术后6,12个月供皮区温哥华瘢痕量表评分高于A、B组(P<0.05);A、C组患者术后12个月日常生活活动能力量表评估优级高于B组(P<0.05);④结果显示,应用人工真皮与自体瘢痕表皮复合移植治疗大面积烧伤后瘢痕挛缩,既能达到与中厚皮移植同样的效果,又能避免供皮区术后瘢痕的再次增生,可缩短供皮区创面愈合时间,相较于单纯移植瘢痕表皮治疗有明显优势。

BACKGROUND:How to provide sufficient skin resources for scar plastic surgery and repair of extensive deep burn patients while avoiding the re-proliferation of scar tissue in the surgical area has always been an important topic in burn and wound repair research.OBJECTIVE:To observe the clinical application effects of artificial dermis combined with autologous scar epidermis in the repair of scar after extensive burns.METHODS:Retrospective analysis was performed on 73 patients with scar hyperplasia and contracture deformity after extensive burns in Bengbu Third People’s Hospital Affiliated to Bengbu Medical College from January 2021 to January 2023. The patients were divided into three groups according to the treatment method: Group A (n=21, artificial dermis combined with autologous scar epidermis transplantation was used for treatment), group B (n=27, scar epidermis was transplanted after scar release in the functional site), and group C (n=25, functional site scar release after transplantation of thick skin treatment). Skin survival and infection at the receiving site, wound healing time at the receiving site and the donor site were recorded in the three groups. The scar status and functional recovery of the recipient area and donor area were evaluated by the Vancouver Scar Scale and activities of daily living. RESULTS AND CONCLUSION: (1) The skin infection rate was lower in group B than that in groups A and C (P < 0.05). The survival grade was higher in group B than that in groups A and C (P < 0.05). (2) The wound healing time at the receiving site was longer in group A than that in groups B and C (P < 0.05). The wound healing time at the receiving site was longer in group C than that in group B (P < 0.05). The wound healing time at the donor site was longer in group C than that in groups A and B (P < 0.05). (3) Vancouver Scar Scale score was higher in group B than that in groups A and C at 12 months postoperatively (P < 0.05). Vancouver Scar Scale score was higher in group C than that in groups A and B at 6 and 12 months postoperatively (P < 0.05). The excellent grade of activities of daily living in groups A and C was significantly higher than that of group B at 12 months postoperatively (P < 0.05). (4) The results showed that the application of artificial dermis combined with autologous scar epidermis composite transplantation in the treatment of scar contracture after extensive burn could not only achieve the same effect as that of intermediate-thickness skin, but also avoid postoperative scar re-hyperplasia at the donor site and shorten the time of complete wound healing at the donor site. Compared with scar epidermal transplantation, this treatment has obvious advantages.