摘要
目的探讨瘢痕断层皮片联合脱细胞异体真皮治疗大面积深Ⅱ度烧伤瘢痕的可行性及疗效。方法2013年1月-12月,收治20例大面积深Ⅱ度烧伤后需行瘢痕整复的患者。男14例,女6例;年龄4-60岁,平均40岁。烧伤原因：热液烫伤10例,火焰烧伤9例,石灰水烧伤1例。烧伤面积为70%-96%总体表面积（total body surface area,TBSA）,平均79%TBSA。创面愈合至瘢痕整复时间3个月-2年,平均7个月。采用自身对照方式,瘢痕彻底切除后,患者右侧关节以厚0.7 mm的瘢痕断层皮片（对照组,n=35）修复,左侧关节以厚0.5 mm的瘢痕断层皮片联合脱细胞异体真皮（试验组,n=30）修复。两组瘢痕部位比较,差异无统计学意义（Z=-1.152,P=0.249）。植皮后负压引流10 d,石膏托固定关节至创面愈合,均行正规康复锻炼。结果两组患者创面愈合、感染发生率以及愈合时间比较,差异均无统计学意义（P〉0.05）。患者均获随访6个月。术后6个月,采用温哥华瘢痕量表（VSS）评价瘢痕情况,试验组为（5.23±1.41）分,对照组为（10.17±2.26）分,比较差异有统计学意义（t=8.925,P=0.000）。参照日常生活活动能力（ADL）分级标准评定关节功能：试验组获优8个,良20个,中1个,差1个;对照组获优3个,良5个,中22个,差5个;比较差异有统计学意义（Z=-4.894,P=0.000）。结论瘢痕断层皮片联合脱细胞异体真皮治疗大面积深Ⅱ度烧伤瘢痕可行且疗效较好。
Objective To investigate the feasibility and effectiveness of using scar split thickness skin grafts combined with acellular allogeneic dermis in the treatment of large deep Ⅱ degree burn scar.Methods Between January 2013 and December 2013,20 cases of large deep Ⅱ degree burn scar undergoing plastic operation were enrolled.There were 14 males and 6 females,aged 4 to 60 years（mean,40 years）.Burn reasons included hydrothermal burns in 10 cases,flame burns in 9 cases,and lime burns in 1 case.The burn area accounted for 70% to 96% total body surface area（TBSA） with an average of 79% TBSA.The time from wound healing to scar repair was 3 months to 2 years（mean,7 months）.Based on self-control,0.7 mm scar split thickness skin graft was used to repair the wound at the right side of joints after scar resection（control group,n=35）,0.5 mm scar split thickness skin graft combined with acellular allogeneic dermis at the left side of joints（trial group,n=30）.Difference was not statistically significant in the scar sites between 2 groups（Z=1.152,P=0.249）.After grafting,negative pressure drainage was given for 10 days;plaster was used for immobilization till wound healing;and all patients underwent regular rehabilitation exercises.Results No significant difference was found in wound healing,infection,and healing time between 2 groups（P〉0.05）.All patients were followed up for 6 months.According to the Vancouver Scar Scale（VSS）,the score was 5.23 ± 1.41 in trial group and was 10.17 ± 2.26 in control group,showing significant difference（t=8.925,P=0.000）.Referring to Activities of Daily Living（ADL） grading standards to assess joint function,the results were excellent in 8 cases,good in 20 cases,fair in 1 case,and poor in 1 case in trial group;the results were excellent in 3 cases,good in 5 cases,fair in 22 cases,and poor in 5 cases in control group;and difference was statistically significant（Z= 4.894,P=0.000）.Conclusion A combination of scar split thickness skin graft and acellular allogeneic dermis in the treatment of large deep Ⅱ degree burn scar is feasible and can become one of solution to the problem of skin source tension.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2014年第12期1502-1504,共3页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
脱细胞异体真皮
瘢痕断层皮片
深Ⅱ度烧伤
瘢痕
Acellular allogeneic dermis
Scar split thickness skin
Deep Ⅱ degree burn
Scar
