Meek skin grafting combined with platelet-rich plasma in repairing of extensive deep burn wounds: a clinical study
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摘要:
目的 探讨Meek皮片移植联合富血小板血浆（PRP）修复大面积深度烧伤创面的临床效果。 方法 本研究为回顾性观察性研究。2018年8月—2023年8月,空军军医大学第一附属医院收治44例符合入选标准的患者,其中男23例、女21例；年龄（22~62）岁；烧伤总面积30%TBSA~80%TBSA,四肢或躯干部位为深Ⅱ~Ⅲ度烧伤。根据治疗过程,将患者分为观察组（21例）和对照组（23例）。针对四肢或躯干的深度烧伤部位,观察组患者接受Meek皮片移植联合PRP同期治疗,对照组患者接受单纯Meek皮片移植。术后10 d,观测患者Meek皮片成活率。术后14 d,观测患者创面愈合率。统计术后创面愈合时间、创面标本细菌培养阳性率。 结果 术后10 d,观察组患者植皮区较为干燥,Meek皮片与创基贴合紧密、色泽多红润,成活率为89%±4%；对照组患者植皮区部分Meek皮片脱落,残余创面呈散在不规则地图状,伴有不同程度脓性分泌物,皮片成活率为79%±6%,明显低于观察组（t=6.72,P<0.05）。术后14 d,观察组中19例患者术区创面完全愈合,另2例患者残余细小创面,经换药延期1周后愈合；对照组中12例患者术区创面完全愈合,6例患者术区创面经补充邮票皮移植术后愈合,5例患者术区创面经常规换药后延期愈合,创面愈合率显著低于观察组（P<0.05）。观察组患者术区创面愈合时间为（13.29±1.65）d,明显短于对照组的（16.39±3.49）d,t=3.72,P<0.05。术后,观察组和对照组患者创面标本细菌培养阳性率比较,差异无统计学意义（P>0.05）。 结论 对于大面积深度烧伤创面,采用Meek皮片移植联合自体PRP较单纯Meek皮片移植治疗,可促进皮片成活,加快皮片扩展融合、缩短创面愈合时间,从而提高治疗效果。 Abstract:Objective To investigate the clinical effects of Meek skin grafting combined with platelet-rich plasma (PRP) in repairing of extensive deep burn wounds. Methods This study was a retrospective observational study. From August 2018 to August 2023, 44 patients who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University, including 23 males and 21 females. Their age ranged from 22 to 62 years old and the total burn area was 30%TBSA-80%TBSA, the burns on limbs or torso were deep partial-thickness to full-thickness. According to the treatment process, the patients were divided into observation group (21 cases) and control group (23 cases). For deep burns on the limbs or torso, patients in observation group were treated with Meek skin grafting combined with PRP at the same time, while patients in control group were treated with Meek skin grafting alone. The survival rate of Meek skin grafts was observed on the 10th day after operation. The wound healing rate of patients was observed on the 14th day after operation. The postoperative wound healing time and positive rate of bacterial culture of wound specimens were recorded. Results On the 10th day after operation, the skin grafting area in observation group were dry, and the skin grafts adhered closely to the wound base with ruddy color, with a survival rate of 89%±4%. Whereas in control group, some skin grafts fell off, and the residual wounds were scattered in irregular map shape, accompanied by purulent secretion. The survival rate of skin grafts was about 79%±6%, which was significantly lower than that in observation group (t=6.72, P<0.05). On the 14th day after operation, 19 patients in observation group had complete wound healing in the operation area, and the other 2 patients had small residual wounds, which healed after 1 week of dressing change; in control group, 12 patients had complete wound healing, 6 patients had wound healing after supplementary stamp skin grafting, and 5 patients had delayed wound healing after dressing change. The wound healing rate was significantly lower than that in observation group (P<0.05). The wound healing time of the operation area in observation group was (13.29±1.65) days, which was significantly shorter than (16.39±3.49) days in control group (t=3.72, P<0.05). There was no statistically significant difference in the positive rate of bacterial culture of wound specimens between the two groups after operation. Conclusions Compared with Meek skin grafting alone, Meek skin grafting combined with autologous PRP can improve the therapeutic effect in the repairing of extensive deep burn wounds, by promoting the survival of skin grafts, accelerating the expansion and fusion of skin grafts, and shortening the wound healing time. -
Key words:
- Burns /
- Platelet-rich plasma /
- Extensive deep burns /
- Meek skin grafting /
- Wound repair
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参考文献
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图 1 Meek皮片移植联合PRP治疗例1患者因火焰导致右下肢严重深度烧伤创面的效果。1A.对右下肢削痂后即刻；1B.对右下肢喷涂PRP后即刻；1C.右下肢行Meek皮片移植后即刻；1D.术后5 d换药时,可见右下肢术区双绉纱干燥,无明显血肿及分泌物；1E.术后10 d换药时,可见右下肢的Meek皮片基本融合；1F.术后14 d,可见右下肢创面基本愈合
注：因对患者左、右腿创面行分期手术修复,简便起见仅对右腿情况进行描述
图 2 采用单纯Meek皮片移植治疗例2患者因火焰导致双下肢严重深度烧伤创面的效果。2A、2B.分别为双下肢创面削痂后即刻的正面观、背面观；2C、2D.分别为左、右下肢创面行Meek微型皮片移植后即刻；2E、2F.分别为术后18 d双下肢残余创面的正面观、背面观,正面中的微型皮片大部分融合,背面中的微型皮片部分融合
Table 1. 2组大面积深度烧伤创面患者的一般资料比较
组别 样本数 性别（例） 年龄（岁, 烧伤总面积（%TBSA, 术前血红蛋白（g/L, 术前白蛋白（g/L, 女 男 观察组 21 10 11 42±10 52±13 102.0±2.7 33.2±2.0 对照组 23 11 12 41±11 50±12 102.6±4.6 33.0±1.8 t值 — 0.26 0.34 0.53 0.35 P值 >0.999 0.398 0.367 0.299 0.364 注：针对四肢或躯干深度烧伤部位,观察组患者接受Meek皮片移植联合PRP同期治疗,对照组患者接受单纯Meek皮片移植 
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Table 2. 2组大面积深度烧伤创面患者各主要观察指标的比较
组别 样本数 术后10 d皮片成活率（%, 术后14 d创面愈合率（%） 创面愈合时间（d, 创面标本细菌培养阳性率（%） 观察组 21 89.33±3.77 90.5 13.29±1.65 19.0 对照组 23 79.09±5.98 52.2 16.39±3.49 21.7 t值 6.72 — 3.72 — P值 <0.001 0.008 0.006 0.318 注：针对四肢或躯干深度烧伤部位,观察组患者接受Meek皮片移植联合PRP同期治疗,对照组患者接受单纯Meek皮片移植
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