足底刃厚皮修复背臀部深度烧伤创面的临床效果

黄书润; 苏惠强; 王一勇; 刘江涛; 张勇; 周博; 庄美平

doi:10.3760/cma.j.cn501225-20220426-00158

足底刃厚皮修复背臀部深度烧伤创面的临床效果

doi: 10.3760/cma.j.cn501225-20220426-00158

解放军联勤保障部队第910医院烧伤整形科，泉州　　362000

基金项目:

南京军区医药卫生科研基金重点课题 11Z025

详细信息

通讯作者:
庄美平，Email：hsr180yy@163.com

计量
- 文章访问数: 144
- HTML全文浏览量: 54
- PDF下载量: 25
- 被引次数: 0
出版历程
- 收稿日期: 2022-04-26

Clinical effects of plantar split-thickness skin grafts in repairing the deep burn wounds in the back and buttocks

Department of Burns and Plastic Surgery, the 910th Hospital of Joint Service Support Unit of PLA, Quanzhou 362000, China

Funds:

Key Project of Medical and Health Research of Nanjing Military Command Fund 11Z025

More Information

Corresponding author: Zhuang Meiping, Email: hsr180yy@163.com

摘要

摘要: 目的探讨足底刃厚皮修复背臀部深度烧伤创面的临床效果。方法采用回顾性观察性研究方法。2011年1月—2022年2月，解放军联勤保障部队第910医院收治98例符合入选标准的深度烧伤患者，其中男64例、女34例，年龄17~78岁，烧伤总面积35%~95%体表总面积（TBSA）。背臀部Ⅲ度烧伤面积为5%~17%TBSA，创面仅采用双足底邮票状刃厚皮修复或联合其他部位Meek微型皮片或邮票状皮片修复。根据双足底取皮次数将患者分为取1次皮组（29例）、取2次皮组（38例）、取3次皮组（21例）、取4次皮组（10例）。统计98例患者双足底每次取皮面积、每次取皮后供区愈合时间及每次取皮后7 d足底皮受区皮片成活率，69例2次及以上取足底皮患者相邻2次取皮间隔时间，4组患者双足底末次取皮后供区愈合时间和受区皮片成活率。随访观察患者足底皮受区外观、质地和瘢痕情况及双足底供区瘢痕和功能情况。对数据行单因素方差分析、Kruskal-Wallis检验、 χ ²检验。结果 98例患者双足底每次取皮面积为2.0%~4.5%［（3.4±0.6）%］TBSA、每次取皮后供区愈合时间为7~10（7.8±1.1）d、每次取皮后7 d足底皮受区皮片成活率为93%（92%，95%）。69例患者足底相邻2次取皮间隔时间为7~38（11.2±0.5）d。4组患者双足底末次取皮后供区愈合时间和受区皮片成活率比较，差异均无统计学意义（ P>0.05）。88例患者随访3个月~5年，足底皮受区外观平整、质地硬实、瘢痕增生轻、抗压耐磨；其中85例患者足底供区恢复好、瘢痕不明显，仅3例患者足底非负重区遗留小片状瘢痕，但不影响行走和穿鞋袜。10例患者出院后失访。结论双足底可反复提供邮票状刃厚皮修复背臀部深度烧伤创面，皮片成活率高，可减轻其他部位供区压力，且抗压耐磨，术后不影响行走。
- 烧伤 /
- 皮肤移植 /
- 背损伤 /
- 臀 /
- 创面修复 /
- 足底皮片
Abstract: Objective To explore the clinical effects of plantar split-thickness skin grafts in repairing the deep burn wounds in the back and buttocks. Methods A retrospective observational study was conducted. From January 2011 to February 2022, 98 patients with deep burn who met the inclusion criteria were admitted to the 910 ^th Hospital of Joint Service Support Unit of PLA, including 64 males and 34 females, aged 17 to 78 years, with total burn areas of 35%-95% total body surface area (TBSA). The area of full-thickness burns in the back and buttocks ranged from 5% to 17% TBSA and the wounds were repaired only using stamp-shaped split-thickness skin grafts from plantar areas of both feet or combined with Meek microskin grafts or stamp-shaped skin grafts from other sites. According to the times of skin graft harvesting from both soles, these patients were divided into one-harvesting group (29 cases), two-harvesting group (38 cases), three-harvesting group (21 cases), and four-harvesting group (10 cases). The area of skin grafts harvested each time from both soles, the healing time of donor sites after each skin graft harvesting, and the survival rate of plantar skin graft in recipient site at 7 days after each skin graft harvesting in 98 patients, the interval between two adjacent skin graft harvesting in 69 patients with skin grafts harvested twice or more, as well as the healing time of donor site and survival rate of skin graft in recipient site after the last skin graft harvesting from both soles of patients in the 4 groups were recorded. The patients were followed up to observe the appearance, texture, and scar in recipient site of plantar skin grafts as well as the scar and function in plantar donor sites. Data were statistically analyzed with one-way analysis of variance, Kruskal-Wallis test, and chi-square test. Results In the 98 patients, the area of skin graft was 2.0%-4.5% ((3.4±0.6)%) TBSA harvested each time from both soles, the healing time of donor site after each skin graft harvesting was 7-10 (7.8±1.1) d, and the survival rate of plantar skin graft in recipient site at 7 days after each skin graft harvesting was 93% (92%, 95%). The interval between two adjacent skin graft harvesting in the 69 patients was 7-38 (11.2±0.5) d. The healing time of donor site and survival rate of skin graft in recipient site after the last skin graft harvesting from both soles of patients in the 4 groups showed no statistically significant differences ( P>0.05). A total of 88 patients were followed up for 3 months to 5 years, the appearance in recipient site of plantar skin graft was smooth, the texture was firm, the scar hyperplasia was mild, and the area was compressive- and wear-resistant. Among them, the plantar donor site recovered well in 85 patients, without obvious scar hyperplasia and only 3 patients had small area of scar hyperplasia in the non-weight-bearing areas which did not affect walking or wearing shoes or socks. Ten patients were lost in the follow up after discharge. Conclusions Stamp-shaped split-thickness skin grafts can be repeatedly harvested from both soles of patient to repair the deep burn wounds in the back and buttocks, with high survival rate of skin grafts, thus can reduce the burden of other donor sites. Moreover, the skin grafts have good wear-resistance and pressure-resistance, without affecting postoperative normal walk.
- Burns /
- Skin transplantation /
- Back injuries /
- Buttocks /
- Wound repair /
- Plantar skin grafts
黄书润：研究设计、论文撰写、临床操作；苏惠强、刘江涛、张勇：手术操作、疗效观察、图片处理；王一勇、周博：数据整理、统计学分析；庄美平：术前供区准备、病例随访

所有作者均声明不存在利益冲突

HTML全文

1 双足底刃厚皮修复深度烧伤患者的背臀部创面。1A.伤后10 d，背臀部烧伤创面被焦痂覆盖；1B.伤后17 d，即背部创面切痂+Meek微型皮移植后7 d，皮片存活不佳；1C.伤后40 d，即第1次取双足底邮票状刃厚皮修复背臀部创面后15 d，皮片存活佳；1D.伤后40 d，第2次取双足底皮片覆盖背臀部创面后；1E.末次双足底取皮后6个月，背臀部植皮区外观平整；1F.末次双足底取皮后6个月，双足外侧遗留少许瘢痕

下载: 全尺寸图片幻灯片

表1 4组采用双足底刃厚皮修复背臀部深度烧伤创面的患者临床资料比较

组别	例数	性别（例）		年龄（岁， x ¯ ± s ）	烧伤总面积［%TBSA， M（ Q ₁， Q ₃）］	Ⅲ度烧伤面积［%TBSA， M（ Q ₁， Q ₃）］
组别	例数	男	女	年龄（岁， x ¯ ± s ）	烧伤总面积［%TBSA， M（ Q ₁， Q ₃）］	全身	背臀部
取1次皮组	29	22	7	44±8	80.0（70.0，83.0）	58.0（45.0，65.0）	13.0（11.0，15.0）
取2次皮组	38	26	12	44±11	81.5（68.0，84.0）	57.0（50.0，70.0）	13.0（13.0，15.0）
取3次皮组	21	10	11	41±8	83.0（76.0，88.0）	62.0（56.0，76.0）	13.0（13.0，14.0）
取4次皮组	10	6	4	39±14	86.0（82.0，91.0）	68.5（52.0，81.0）	14.0（13.0，15.0）
统计量值		χ ²=4.61		F=0.94	χ ²=7.49	χ ²=7.62	χ ²=1.14
P值		0.202		0.426	0.058	0.055	0.768
注：TBSA为体表总面积

下载: 导出CSV

表2 4组采用双足底刃厚皮修复背臀部深度烧伤创面的患者双足底末次取皮后供区愈合时间和受区皮片成活率比较

组别	例数	供区愈合时间［d， M（ Q ₁， Q ₃）］	受区皮片成活率［%， M（ Q ₁， Q ₃）］
取1次皮组	29	8.0（7.0，9.0）	94.0（93.0，94.0）
取2次皮组	38	7.0（7.0，8.0）	93.0（92.0，94.0）
取3次皮组	21	7.0（7.0，8.0）	93.0（93.0，95.0）
取4次皮组	10	8.0（8.0，9.0）	94.0（93.0，95.0）
χ ²值		5.51	2.68
P值		0.138	0.444

下载: 导出CSV

参考文献(35)

[1]	黄跃生.烧伤外科学[M].北京:科学技术文献出版社,2010:553.
[2]	侯玉森,刘立强,曹玉珏,等.股部交腿扩张皮瓣技术在修复全足底大面积软组织缺损中的应用[J].中华整形外科杂志,2020,36(7):780-783.DOI: 10.3760/cma.j.cn114453-20200402-00199.
[3]	寿倍明,谭谦,孙炳伟,等.“八二”昆山工厂铝粉尘爆炸事故群体特重度烧伤患者创面处理经验[J].中华烧伤杂志,2018,34(6):339-342.DOI: 10.3760/cma.j.issn.1009-2587.2018.06.005.
[4]	李志清,王甲汉,邱学文,等.用阴囊足底自体皮修复特重度烧伤皮源奇缺创面三例[J].中华烧伤杂志,2010,26(1):49.DOI: 10.3760/cma.j.issn.1009-2587.2010.01.018.
[5]	高黎明,亓红英,刘希锋,等.特大面积深度烧伤合并吸入性损伤一例[J].中华烧伤杂志,2005,21(3):202.DOI: 10.3760/cma.j.issn.1009-2587.2005.03.035.
[6]	徐建军,林才.微型皮片移植方法在大面积深度烧伤中的应用[J/CD].中华损伤与修复杂志:电子版,2011,6(1):111-117.DOI: 10.3877/cma.j.issn.1673-9450.2011.01.022.
[7]	FarrokhiA, PakyariM, NabaiL, et al. Evaluation of detergent-free and detergent-based methods for decellularization of murine skin[J]. Tissue Eng Part A, 2018, 24(11/12): 955-967.DOI: 10.1089/ten.TEA.2017.0273.
[8]	伍锦华,柴家科,杨红明,等.救治特重度烧伤并发左侧胸腔积液一例[J].中华烧伤杂志,2004,20(2):121.DOI: 10.3760/cma.j.issn.1009-2587.2004.02.039.
[9]	谭谦.群体烧伤救治面临的挑战:从“八二”昆山工厂铝粉尘爆炸事故烧伤伤员救治谈起[J].中华烧伤杂志,2018,34(6):329-331.DOI: 10.3760/cma.j.issn.1009-2587.2018.06.003.
[10]	张树堂,李树仁,田社民,等.治愈100%TBSA严重烧伤合并重度吸入性损伤一例[J].中华烧伤杂志,2003,19(1):54.
[11]	曹胜军,丰波,王凌峰,等.足底内侧岛状皮瓣修复足底负重区创面11例[J].中华烧伤杂志,2017,33(7):455-457.DOI: 10.3760/cma.j.issn.1009-2587.2017.07.016.
[12]	EryilmazT,TelliogluAT,OzakpinarHR,et al.Correction of hyperpigmented palmar grafts with full-thickness skin grafts from the lateral aspect of the foot[J].J Plast Surg Hand Surg,2013,47(5):405-408.DOI: 10.3109/2000656X.2013.773517.
[13]	吴霄,伍翰笙,邓建林,等.足底内侧动脉穿支皮瓣移植修复手部掌侧瘢痕挛缩的早期康复[J].中华显微外科杂志,2021,44(2):184-187.DOI: 10.3760/cma.j.cn441206-20200318-00155.
[14]	中华医学会烧伤外科学分会MEEK植皮技术中心协作组,海军军医大学第一附属医院烧伤外科,全军烧伤研究所.MEEK微型皮片移植技术临床操作规范[J].中华烧伤杂志,2019,35(8):561-564.DOI: 10.3760/cma.j.issn.1009-2587.2019.08.001.
[15]	李小毅,黄书润,魏智艺,等.特重度烧伤86例自体供皮区分析[J].感染、炎症、修复,2013,14(1):38-40.DOI: 10.3969/j.issn.1672-8521.2013.01.012.
[16]	张高飞,刘文军,王迪,等.微粒皮和Meek微型皮片移植修复大面积深度烧伤创面临床效果的荟萃分析[J].中华烧伤杂志,2020,36(7):560-567.DOI: 10.3760/cma.j.cn501120-20190521-00249.
[17]	柴家科,郑庆亦,李利根,等.“八二”昆山工厂铝粉尘爆炸事故八例特重度烧伤伤员救治分析[J].中华烧伤杂志,2018,34(6):332-338.DOI: 10.3760/cma.j.issn.1009-2587.2018.06.004.
[18]	郭慧芳.Meek植皮术修复患儿大面积烧伤创面的效果研究[J].中国美容医学,2018,27(5):58-60.
[19]	狄海萍,牛希华,李强,等.Meek植皮在不同年龄段大面积深度烧伤患者中的应用效果[J].中华烧伤杂志,2017,33(3):156-159.DOI: 10.3760/cma.j.issn.1009-2587.2017.03.006.
[20]	KimKS,KimES,HwangJH,et al.Medial sural perforator plus island flap: a modification of the medial sural perforator island flap for the reconstruction of postburn knee flexion contractures using burned calf skin[J].J Plast Reconstr Aesthet Surg,2012,65(6):804-809.DOI: 10.1016/j.bjps.2011.12.018.
[21]	AlmodumeeghA,HeidekruegerPI,NinkovicM,et al.The MEEK technique: 10-year experience at a tertiary burn centre[J].Int Wound J,2017,14(4):601-605.DOI: 10.1111/iwj.12650.
[22]	王春华,余又新,胡德林,等.不同植皮方式在修复大面积烧伤创面中疗效的对比研究[J].安徽医科大学学报,2015,50(8):1136-1138.
[23]	金园园.Meek植皮术与邮票植皮术修复大面积烧伤创面的疗效及应用价值的Meta分析[J].河南外科学杂志,2019,25(4):6-9.
[24]	栗申,郭素娟.邮票皮、meek微型皮与微粒皮三种植皮方式在修复大面积皮肤缺损创面中的疗效对比研究[J].四川解剖学杂志,2018,26(2):81-83.DOI: 10.3969/j.issn.1005-1457.2018.02.030.
[25]	江碧川,高优,郭志谦,等.邮票皮、Meek皮在大面积烧伤患者创面修复作用中的对比[J].中国医师杂志,2020,22(10):1533-1536.DOI: 10.3760/cma.j.cn431274-20190924-01107.
[26]	覃凤均,陈忠,赵耀华,等.学科合作在“八二”昆山工厂铝粉尘爆炸事故群体特重度烧伤患者救治中的作用分析[J].中华烧伤杂志,2018,34(6):349-353.DOI: 10.3760/cma.j.issn.1009-2587.2018.06.007.
[27]	宋国栋,高聪,石文,等.灾害性群体烧伤早期救治的现状及思考[J].中华医学杂志,2017,97(6):401-405.DOI: 10.3760/cma.j.issn.0376-2491.2017.06.001.
[28]	罗高兴.烧伤创面的早期精确诊断与正确处理[J].中华烧伤杂志,2017,33(10):593-596.DOI: 10.3760/cma.j.issn.1009-2587.2017.10.001.
[29]	周鑫,刘东,欧昌良,等.带感觉神经的足内侧静脉皮瓣在末节指腹缺损中的应用[J].中华手外科杂志,2020,36(2):122-125.DOI: 10.3760/cma.j.cn311653-20190828-00242.
[30]	杨迎秋,周鑫,刘安铭,等.足底内侧动脉皮瓣修复拇指和手指指腹缺损十例[J].中华显微外科杂志,2022,45(4):426-430.DOI: 10.3760/cma.j.cn441206-20220425-00082.
[31]	StanecZ,KrivićA,StanecS,et al.Heel reconstruction with an iliac osteocutaneous free flap: 10-year follow-up[J].Ann Plast Surg,2004,53(2):174-177.DOI: 10.1097/01.sap.0000099704.02280.d6.
[32]	周荣,巨积辉,唐林峰,等.带感觉神经的股前外侧穿支皮瓣修复足底皮肤软组织缺损的临床效果[J].中华烧伤杂志,2021,37(5):453-459.DOI: 10.3760/cma.j.cn501120-20200309-00136.
[33]	杨学林,刘春,胡福兴,等.含神经的游离足底内侧皮瓣修复小儿足跟软组织缺损[J].中华整形外科杂志,2021,37(11):1251-1255.DOI: 10.3760/cma.j.cn114453-20200127-00021.
[34]	秦小琰,肖军,李天武,等.儿童手部掌侧皮肤缺损全厚皮片移植术供区优化选择[J].中华整形外科杂志,2022,38(5):549-557.DOI: 10.3760/cma.j.cn114453-20200229-00088.
[35]	FrielMT,DuquetteSP,RanganathB,et al.The use of glabrous skin grafts in the treatment of pediatric palmar hand burn[J].Ann Plast Surg,2015,75(2):153-157.DOI: 10.1097/SAP.0000000000000558.