人工真皮联合自体刃厚皮移植在手部严重烧伤后瘢痕挛缩治疗中的临床效果

Clinical effects of artificial dermis combined with autologous split-thickness skin graft in the treatment of severe hand burn scar contracture

目的探讨人工真皮联合自体刃厚皮治疗手部严重烧伤后瘢痕挛缩的临床效果。方法2018年1月至2022年12月宁波市第六医院整复外科收治的手部严重烧伤后瘢痕挛缩患者17例(22只患手),其中男14例,女3例,年龄24~81岁。采用人工真皮联合自体刃厚皮进行治疗,一期手术行瘢痕挛缩松解,关节复位内固定,双层人工真皮植皮,持续负压吸引等治疗;二期行刃厚皮片移植修复创面。术后进行主被动功能锻炼、弹力加压治疗、激光治疗及硅酮类药物外用预防瘢痕增生。测量术前和术后6个月手指关节总活动度(TAM)、日常生活活动能力量表(ADL)评分;观察植皮区皮肤质地、色素情况。结果治疗后患者手部关节TAM明显增加[(37.05±16.23)°vs.(183.64±15.97)°,t=-30.191,P<0.001],ADL评分明显提高[(43.24±9.51)分vs.(84.41±6.09)分,t=-15.031,P<0.001]。随访6~18个月,手部植皮区皮肤柔软,有滑动度,未见明显二次挛缩,其中5例患者植皮区出现明显色素沉着。结论人工真皮联合自体刃厚皮移植治疗手部严重烧伤后瘢痕挛缩,能有效改善手部功能障碍,增强患者自理能力,提高患者生存质量。

Objective To explore the clinical effects of artificial dermis combined with autologous splitthickness skin graft in the treatment of severe hand burn scar contracture.Methods From January 2018 to December 2022,17 patients(22 affected hands)with severe hand burn scar contracture were treated at Plastic and Reconstructive Surgery Department of the Sixth Hospital of Ningbo,including 14 males and 3 females,aged 2481 years old.Artificial dermis combined with autologous splitthickness skin was used for treatment.Scar contracture release,joint reduction and internal fixation,doublelayer artificial dermis skin grafting,and continuous negative pressure suction were conducted in the first stage surgery.Splitthickness skin graft was used for wound repair in the second stage surgery.Functional exercise,elastic compression therapy,laser therapy,and topical use of silicone drugs were performed to prevent scar hyperplasia.Measured total active motion(TAM)of finger and activities of daily living(ADL)scores before and 6 months after surgery.Observed the texture and pigmentation of the skin in the graft area.Results After treatment,the TAM of finger improved[(37.05±16.23)°vs.(183.64±15.97)°,t=-30.191,P<0.001]and ADL score enhanced significantly[(43.24±9.51)vs.(84.41±6.09),t=-15.031,P<0.001].The patients were followed up for 618 months,the skin in the graft area was soft and smooth,with no obvious secondary contractures observed.Five cases occured significant pigmentation in the graft area.Conclusion The combination of artificial dermis and autologous splitthickness skin graft can effectively improve hand dysfunction,enhance selfcare ability,and improve quality of life in the treatment of severe hand burn scar contracture.