Clinical effects of plantar split-thickness skin grafts in repairing the deep burn wounds in the back and buttocks
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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。 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. -
Key words:
- Burns /
- Skin transplantation /
- Back injuries /
- Buttocks /
- Wound repair /
- Plantar skin grafts
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参考文献
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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
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， 烧伤总面积［%TBSA， M（ Q 1， Q 3）］ Ⅲ度烧伤面积［%TBSA， M（ Q 1， Q 3）］ 男 女 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 
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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
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