Analysis of clinical effects of artificial dermis in functional reconstruction in the late stage of extremely severe burn
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摘要: 目的 探讨人工真皮联合自体刃厚皮移植在特重度烧伤后期功能重建中的临床应用效果。 方法 回顾性分析2015年5月—2017年5月在笔者医院行手术治疗、在本院联盟康复医院昆山周市康复医院行康复治疗的,2014年"八二"昆山工厂铝粉尘爆炸事故中致伤的、特重度烧伤后瘢痕增生功能活动受限患者中40例符合入选标准患者的病历资料。按其采用的治疗方法,20例患者纳入人工真皮组(男12例、女8例,年龄为20~45岁),行Ⅰ期功能部位瘢痕松解植入人工真皮(皮耐克)+Ⅱ期移植自体刃厚皮;另20例患者纳入常规植皮组(男14例、女6例,年龄为20~45岁),行Ⅰ期功能部位瘢痕松解后自体薄中厚皮移植。自体皮移植术后5 d,计算2组患者自体皮成活率;记录2组患者的自体皮感染情况;记录2组患者受皮区完全愈合时间;分别于自体皮移植术后3、6、10个月,采用温哥华瘢痕量表(VSS)评定2组患者受皮区瘢痕情况;记录2组患者供皮区完全愈合时间;于自体皮移植术后10个月,采用VSS评估2组患者供皮区瘢痕情况;自体皮移植术后12个月,评估2组患者手术功能重建部位功能恢复情况并评级。对数据行
t 检验、重复测量方差分析、Wilcoxon秩和检验、χ 2检验、Fisher确切概率法检验及Bonferroni校正。 结果 (1)自体皮移植术后5 d,人工真皮组患者自体皮成活率为(95±3)%,与常规植皮组的(93±3)%相近(t =1.262,P >0.05)。2组患者自体皮感染情况相近(P >0.05)。(2)自体皮移植术后,人工真皮组患者受皮区完全愈合时间为(12.3±2.5)d,与常规植皮组的(12.7±2.0)d相近(t =-0.139,P >0.05)。人工真皮组患者自体皮移植术后3、6、10个月受皮区瘢痕VSS评分均明显低于常规植皮组(t =-4.428、-5.655、-6.839,P <0.01)。(3)自体皮移植术后,人工真皮组患者供皮区完全愈合时间明显短于常规植皮组(t =-12.435,P <0.01);自体皮移植术后10个月,人工真皮组患者供皮区瘢痕VSS评分明显低于常规植皮组(t =-16.971,P <0.01)。(4)自体皮移植术后12个月,人工真皮组患者功能部位功能改善为好的4例、较好15例、差1例,常规植皮组患者功能部位功能改善为好的5例、较好8例、差7例,2组患者功能部位功能改善效果相近(Z =371.5,P >0.05)。 结论 与常规Ⅰ期瘢痕松解+自体薄中厚皮移植相比,Ⅰ期瘢痕松解+人工真皮移植结合Ⅱ期自体刃厚皮移植不影响患者早期皮片存活且都能有效改善功能部位功能情况、降低供受皮区VSS评分、缩短供皮区完全愈合时间。Abstract: Objective To explore the clinical effects of artificial dermis combined with autologous split-thickness skin transplantation in the treatment of functional reconstruction in the late stage of extremely severe burn. Methods From May 2015 to May 2017, medical records of 40 patients with limited activity after scar hyperplasia and conforming to the study criteria, injured in August 2nd Kunshan factory aluminum dust explosion accident in 2014, and had surgeries in our hospital and rehabilitation treatment in our hospital′s alliance rehabilitation hospital, Rehabilitation Hospital of Kunshan Zhou City, were retrospectively analyzed. According to the treatment methods, 20 patients (12 males and 8 females, aged 20 to 45 years) were enrolled in artificial dermis group. They were conducted with stage Ⅰ functional site scar loosening and artificial dermis (PELNAC) implanting+ stage Ⅱ transplantation of autologous split-thickness skin. Another 20 patients (14 males and 6 females, aged 20 to 45 years) were enrolled in conventional skin grafting group. They were conducted with stage Ⅰ functional site scar loosening and transplantation of autologous thin medium-thickness skin. After 5 days of autologous skin transplantation, the survival rates of autologous skin in patients of 2 groups were calculated. The autologous skin infection and complete healing time of skin grafting area in patients of 2 groups were recorded. In 3, 6, and 10 months after autologous skin transplantation, the Vancouver Scar Scale (VSS) was used to assess the scar condition of recipient site in patients of 2 groups. The complete healing time of donor site in patients of 2 groups was recorded. In 10 months after autologous skin transplantation, VSS was used to assess the scar condition of donor site in patients of 2 groups. In 12 months after autologous skin transplantation, the functional recovery of surgical function reconstruction site in patients of 2 groups was evaluated and rated. Data were processed witht test, analysis of variance for repeated measurement, Wilcoxon rank-sum test, chi-square test, Fisher′s exact probability test, and Bonferroni correction. Results (1) After 5 days of autologous skin transplantation, the survival rate of autologous skin in patients of artificial dermis group was (95±3)%, similar to (93±3)% in conventional skin grafting group (t =1.262,P >0.05). The results of autologous skin infection of patients in the 2 groups were similar (P >0.05). (2) After autologous skin grafting, the complete healing time of skin grafting area in patients of artificial dermis group was (12.3±2.5) d, similar to (12.7±2.0) d of conventional skin grafting group (t =-0.139,P >0.05). In 3, 6, and 10 months after autologous skin transplantation, the VSS scores of scars in recipient site of patients in artificial dermis group were significantly lower than those of conventional skin grafting group (t =-4.428, -5.655, -6.839,P <0.01). (3) After autologous skin grafting, the complete healing time of donor site in patients of artificial dermis group was obviously shorter than that in conventional skin grafting group (t =-12.435,P <0.01). In 10 months after autologous skin transplantation, the VSS score in donor site of patients in artificial dermis group was significantly lower than that of conventional skin grafting group (t =-16.971,P <0.01). (4) After 12 months of autologous skin transplantation, the functional improvement levels of the functional site of patients in artificial dermis group were good in 4 patients, fair in 15 patients, and bad in 1 patient, while the functional improvement levels of the functional site of patients in conventional skin grafting group were good in 5 patients, fair in 8 patients, and bad in 7 patients. The functional improvement levels of the functional site of patients between the two groups were similar (Z =371.5,P >0.05). Conclusions Compared with conventional stage Ⅰ functional site scar loosening and transplantation of autologous thin medium-thickness skin, stage Ⅰ functional site scar loosening and artificial dermis implanting+ stage Ⅱ transplantation of autologous split-thickness skin does not affect the survival of skin in the early stage and can effectively improve functional site function, reduce VSS scores of donor site and recipient site, and shorten complete healing time of donor site.-
Key words:
- Burns /
- Cicatrix /
- Skin, artificial /
- Function reconstruction
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