摘要
背景:深度或混合度烧伤后,真皮虽然受到损害,但没有完全坏死,可能只是发生了变性而已,当变性真皮被自体皮片覆盖后,变性真皮能够逐渐复苏,其形态、结构逐渐恢复到正常或接近正常状态。目的:对比分析功能部位深度烧伤切削痂植皮时保留变性真皮与不保留变性真皮的远期疗效。设计、时间及地点:病例分析,于2006-03/2008-06在东莞市清溪医院烧伤外科完成。对象:选用58例有功能部位深度烧伤的患者,按照不同的治疗方法分成3组。方法:切除真皮组:进行切削痂时切除全层真皮并移植大张自体中厚皮片。保留真皮组:用削痂或刮痂的方法清除已经坏死的痂皮,保留变性真皮。对照组:临床治疗过程中不同意手术植皮治疗的部分患者,用通常烧伤换药的方法直至创面愈合。主要观察指标:比较3组患者出血情况、术后瘢痕增生情况,并对其功能进行评级。结果:切除真皮组、保留真皮组手术时,保留真皮组出血少,保留真皮组移植皮片相对切除真皮组不容易成活,切除真皮组皮片收缩较保留真皮组明显,且远期功能不如保留真皮组。3组中对照组瘢痕增生最明显,功能恢复最差。结论:对功能部位深度烧伤切削痂植皮时保留变性真皮并移植大张自体皮片的手术方法能够获得较好的外观及功能。
BACKGROUND： There was degeneration in the dermis only, but not necrosis completely after deep burn or mixed Degree Burns. After treatment with auto-skin grafting, the denatured dermis will recover to normal or close to normal morphology and structure.
OBJECTIVE： To comparatively analyze the long-term effect of repair of deeply burned in function regions with large sheet of split-thickness auto-skin grafting with the preservation of denatured dermis or not during eschar shaving.
DESIGN, TIME AND SETTING： A case analysis was performed in Department of Burnt Surgery of Dongguan Qingxi Hospital from March 2006 to June 2008.
PATICIPANTS： Fifty-eight patients with deep burn in function regions were randomly divided into three groups according to different therapy ways.
METHODS： The denatured dermis of patients in derma excised group was cut completely during eschar shaving and large sheet of split-thickness auto-skin was transplanted. The necrotic crust was cleared away with pare scab or scrape scabby method and reserved the denatured derma in derma reserved group. The patients who did not agree to operating skin transplanted on clinic served as control group, and they were treated with dressing change means till wound healing.
MAIN OUTCOME MEASURES： Comparison of the bleeding volume in operation and scar proliferation after operating among the three groups, and evaluation the grade of the function.
RESULTS： The bleeding volume in derma reserved group was less than that in dermis excised group during the operation. The survival rate of grafting skin in derma reserved group was lower than that in derma excised group. The shrinkage of grafting skin in derma excised group was more obvious than that in derma reserved group, and the long-term function would be worse than that in derma reserved group. The scar proliferation in control group was most obvious and the recovery of function was worst among the three groups.
CONCLUSION： The good show and function was obtained to recovery of deep burn
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2009年第5期957-960,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
