人工真皮联合自体皮修复儿童手指电烧伤后骨骼和/或肌腱外露创面的效果

杨焕纳; 梁琰; 韩大伟; 刘磊; 谢江帆; 田社民; 夏成德; 魏莹

doi:10.3760/cma.j.cn501225-20231101-00168

人工真皮联合自体皮修复儿童手指电烧伤后骨骼和/或肌腱外露创面的效果

doi: 10.3760/cma.j.cn501225-20231101-00168

郑州市第一人民医院烧伤科，郑州　　450004

基金项目:

河南省医学科技攻关计划联合共建项目 LHGJ20191002, LHGJ20210714, LHGJ20210715

详细信息

通讯作者:
魏莹，Email：wyben2012@163.com

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出版历程
- 收稿日期: 2023-11-01
- 网络出版日期: 2023-12-19

Effects of artificial dermis combined with autologous skin in repairing the wounds with exposed bone and/or tendon in fingers of children after electric burns

Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China

Funds:

Joint Construction Project of Henan Medical Science and Technology Research Plan LHGJ20191002, LHGJ20210714, LHGJ20210715

More Information

Corresponding author: Wei Ying, Email: wyben2012@163.com

摘要

摘要: 目的探讨人工真皮联合自体皮修复儿童手指电烧伤后骨骼和/或肌腱外露创面的效果。方法采用回顾性观察性研究方法。2017年1月—2022年12月，郑州市第一人民医院收治14例符合入选标准的手指电烧伤后骨骼和/或肌腱外露创面患儿，其中男9例、女5例，年龄2~11岁。共38指受累，每指1处创面。对所有创面于Ⅰ期清创后行人工真皮覆盖联合负压封闭引流，清创后创面面积为2.0 cm×1.0 cm~4.5 cm×2.5 cm。Ⅱ期行背部自体薄中厚皮移植封闭创面，术后嘱患者尽早行功能康复锻炼。Ⅱ期术后7 d观察自体皮存活情况，记录创面愈合时间；随访12个月，采用温哥华瘢痕量表评估患指植皮区瘢痕增生情况；测量患指关节总主动活动度（TAM），评价患指功能恢复情况；采用自制疗效满意度评分表调查患儿监护人对患儿疗效的满意度。结果 Ⅱ期术后7 d，所有患儿自体皮均存活良好。创面愈合时间为（24.1±2.7）d。随访12个月，患指植皮区瘢痕评分为（5.2±2.4）分；患指关节TAM为（177±40）°，功能评定为良者12指、中者23指、差者3指；在患儿监护人对患儿疗效的满意度调查中：非常满意者10例、满意者3例、不满意者1例。结论人工真皮联合自体薄中厚皮是一种可供选择的有效修复儿童手指电烧伤后骨骼和/或肌腱外露创面的手术方法，创面愈合后瘢痕轻，手指功能恢复好，患儿监护人对患儿疗效的满意度高，值得临床推广。
- 烧伤，电 /
- 儿童 /
- 皮肤，人工 /
- 骨骼外露 /
- 肌腱外露 /
- 创面修复
Abstract: Objective To explore the effects of artificial dermis combined with autologous skin in repairing the wounds with exposed bone and/or tendon in fingers of children after electric burns. Methods A retrospective observational study was conducted. From January 2017 to December 2022, 14 children with bone and/or tendon exposed wounds in fingers after electric burns who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, including 9 males and 5 females, aged 2 to 11 years. A total of 38 fingers were affected, with 1 wound per finger. After debridement, artificial dermal coverage combined with vacuum sealing drainage was performed in all the wounds in the first stage, with wound area of 2.0 cm×1.0 cm-4.5 cm×2.5 cm after debridement. The second stage surgery was performed to close the wound with autologous thin intermediate thickness skin graft. Then the children were told to perform functional rehabilitation exercise as early as possible. The survival of autologous skin graft was observed at the 7 ^th day after the second stage surgery. The wound healing time was recorded. After 12 months of follow-up, the Vancouver scar scale was used to evaluate the scar hyperplasia at the skin grafting site of the affected finger; the total action mobility (TAM) of the affected finger joint was measured for evaluating the functional recovery of the affected finger; a self-made efficacy satisfaction rating table was used to investigate the parents' satisfaction with the curative effect of the children. Results At the 7 ^th day after the second stage surgery, all the children had good survival of autologous skin grafts. The wound healing time was (24.1±2.7) d. After 12 months of follow-up, the scar score at the skin grafting site of the affected finger was 5.2±2.4; the TAM of the affected finger joint was (177±40)°; the functional assessment was good in 12 fingers, medium in 23 fingers, and poor in 3 fingers; the parents' satisfaction with the curative effect of the children in the survey was very satisfied in 10 cases, satisfied in 3 cases, and dissatisfied in 1 case. Conclusions The combination of artificial dermis and autologous thin intermediate thickness skin graft is an alternative surgical method that can effectively repair the bone and/or tendon exposed wounds in fingers of children after electric burns. After wound healing, the scars are slight, the finger function is well recovered, and the parents of the children are highly satisfied with the curative effect of the children, which is worthy of clinical promotion.
- Burns, electric /
- Child /
- Skin, artificial /
- Exposure of bones /
- Exposure of tendons /
- Wound repair
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1 人工真皮+自体背部薄中厚皮修复儿童左手手指电烧伤后骨骼与肌腱外露创面。1A.术前左手示指、中指指背基底呈黄褐色焦痂；1B.术中清创后可见示指、中指远端指间关节腔开放，部分骨皮质外露坏死，伸指肌腱外露且部分坏死，用注射器针头将示指、中指远端指间关节固定于伸直位；1C.Ⅰ期人工真皮移植术后即刻；1D.人工真皮移植术后联合负压封闭引流即刻；1E.负压封闭引流术后2周，创面床完全血管化，肉芽组织生长良好；1F.Ⅱ期行自体薄中厚皮移植术后即刻；1G、1H.分别为术后随访12个月患指外观、屈曲功能，均良好

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