人工真皮修复婴幼儿中小面积深Ⅱ度烫伤创面的效果

丁雄辉; 肖军; 李天武; 毛小波; 周荣; 邱林

doi:10.3760/cma.j.cn501225-20250512-00219

人工真皮修复婴幼儿中小面积深Ⅱ度烫伤创面的效果

doi: 10.3760/cma.j.cn501225-20250512-00219

重庆医科大学附属儿童医院烧伤整形科,国家儿童健康与疾病临床医学研究中心,儿童发育疾病研究教育部重点实验室,结构性出生缺陷与器官修复重建重庆市重点实验室,重庆　　400014

基金项目:

重庆市科卫联合医学科研项目中青年高端人才项目 2024GDRC010

详细信息

通讯作者:
邱林,Email：qiulin118@126.com

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出版历程
- 收稿日期: 2025-05-12

Efficacy of artificial dermis in repairing small to medium-sized deep partial-thickness scalds in infants and young children

Department of Burn and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center of Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing 400014, China

Funds:

Chongqing Medical Scientific Research Project (Joint Project of Chongqing Health Commission and Science and Technology Bureau, 2024GDRC010) 2024GDRC010

More Information

Corresponding author: Qiu Lin, Email: qiulin118@126.com

摘要

摘要: 目的探讨人工真皮修复婴幼儿中小面积深Ⅱ度烫伤创面的效果。方法该研究为回顾性观察性研究。2022年6月—2024年10月,重庆医科大学附属儿童医院（以下简称本单位）收治149例符合入选标准的中小面积深Ⅱ度烫伤患儿,其中男96例、女53例,年龄2 d~3岁。根据创面处理方式,将患儿分为单纯清创组（55例）、人工真皮组（31例）、自体刃厚皮组（36例）、联合植皮组（27例）,对第1组患儿创面仅行清创术处理,对后3组患儿创面于清创术后分别行人工真皮移植、自体刃厚皮移植、人工真皮联合自体刃厚皮移植。自体刃厚皮的供区为头部、背部和大腿外侧。清创术后,取单纯清创组和人工真皮组患儿创面分泌物标本进行微生物检测并计算其检出率,观察创面感染情况。统计4组患儿创面愈合时间及住院时间（指在本单位烧伤整形科的住院时间,下同）。创面愈合后6个月随访时,采用改良温哥华瘢痕量表（mVSS）评估4组患儿瘢痕（指原发创区瘢痕,下同）情况,并记录mVSS总分及其中的柔软度评分。瘢痕mVSS总分为主要观察指标,其余指标为次要观察指标。结果清创术后,单纯清创组患儿创面分泌物标本的微生物检出率为29.1%（16/55）,显著高于人工真皮组的9.7%（3/31）,χ²=4.34,P<0.05；单纯清创组中2例患儿创面发生感染,而人工真皮组中无患儿创面发生感染。与单纯清创组相比,人工真皮组、自体刃厚皮组、联合植皮组患儿创面愈合时间均显著缩短（P<0.05）；与人工真皮组相比,自体刃厚皮组患儿创面愈合时间显著缩短（P<0.05）；与自体刃厚皮组相比,联合植皮组患儿创面愈合时间显著延长（P<0.05）。与单纯清创组相比,人工真皮组、自体刃厚皮组患儿住院时间均显著缩短（P<0.05）；与人工真皮组相比,自体刃厚皮组患儿住院时间显著缩短（P<0.05）,联合植皮组患儿住院时间显著延长（P<0.05）；与自体刃厚皮组相比,联合植皮组患儿住院时间显著延长（P<0.05）。创面愈合后6个月随访时,单纯清创组患儿瘢痕mVSS总分为（8.1±1.1）分,显著高于人工真皮组的（6.8±0.9）分（均数差值为1.3分,95%置信区间为0.8~1.8分,P<0.05）,显著低于自体刃厚皮组的（9.4±1.5）分（均数差值为-1.3分,95%置信区间为-1.8~-0.8分,P<0.05）；与人工真皮组相比,自体刃厚皮组患儿瘢痕mVSS总分显著升高（均数差值为-2.6分,95%置信区间为-3.2~-2.0分,P<0.05）；与自体刃厚皮组相比,联合植皮组患儿瘢痕mVSS总分（7.7±1.0）分显著降低（均数差值为1.7分,95%置信区间为1.1~2.3分,P<0.05）。与单纯清创组相比,人工真皮组患儿瘢痕柔软度评分显著降低（P<0.05）；与人工真皮组相比,自体刃厚皮组患儿瘢痕柔软度评分显著升高（P<0.05）；与自体刃厚皮组相比,联合植皮组患儿瘢痕柔软度评分显著降低（P<0.05）。结论采用人工真皮修复婴幼儿中小面积深Ⅱ度烫伤创面,可以改善瘢痕质量,减少创面感染风险,相对缩短创面愈合时间,尤其适用于重视美观和功能预后的婴幼儿群体。
- 烧伤 /
- 瘢痕 /
- 人工真皮 /
- 婴幼儿 /
- 深Ⅱ度烫伤 /
- 创面修复 /
- 改良温哥华瘢痕量表 /
- 疗效
Abstract: Objective To investigate the efficacy of artificial dermis in repairing small to medium-sized deep partial-thickness scalds in infants and young children. Methods The study was a retrospective observational study. From June 2022 to October 2024, 149 infants and young children with small to medium-sized deep partial-thickness scalds meeting the inclusion criteria were admitted to the Children's Hospital of Chongqing Medical University (hereinafter referred to as our institution). There were 96 males and 53 females, aged from 2 days to 3 years. Based on wound management method, the children were divided into debridement-alone group (n=55), artificial dermis group (n=31), autologous split-thickness skin group (n=36), and combined skin grafting group (n=27). Wounds in the first group of children underwent debridement alone. Wounds in the latter three groups of children were treated with artificial dermis transplantation, autologous split-thickness skin grafts transplantation, or artificial dermis combined with autologous split-thickness skin grafts transplantation, respectively, following debridement. Donor sites for autologous split-thickness skin grafts were the head, back, or lateral thigh. After debridement, wound secretion specimens were collected from the debridement-alone group and artificial dermis group of children for microbial detection, the detection rate was calculated, and wound infection was observed. Wound healing time and length of hospital stay (referring to the length of hospital stay in the Department of Burn and Plastic Surgery of our institution, the same hereafter) were recorded in four groups of children. At the 6-month follow-up after wound healing, the scar (referring to primary wound site scars, the same hereafter) condition of four groups of children was assessed using the modified Vancouver scar scale (mVSS), and both total mVSS score and pliability score were recorded. The total mVSS score of scars was the primary outcome indicator; other indicators were secondary outcome. Results After debridement, the microbial detection rate in wound secretion specimens of children in debridement-alone group was 29.1% (16/55), significantly higher than 9.7% (3/31) in artificial dermis group, χ²=4.34, P<0.05. Wound infection occurred in 2 children in debridement-alone group, whereas no wound infection occurred in children in artificial dermis group. Compared with that in debridement-alone group, the wound healing time of children in artificial dermis group, autologous split-thickness skin group, and combined skin grafting group was significantly shortened (P<0.05). Compared with that in artificial dermis group, the wound healing time of children in autologous split-thickness skin group was significantly shortened (P<0.05). Compared with that in autologous split-thickness skin group, the wound healing time of children in combined skin grafting group was significantly prolonged (P<0.05). Compared with that in debridement-alone group, the length of hospital stay of children in artificial dermis group and autologous split-thickness skin group was significantly shortened (P<0.05). Compared with that in artificial dermis group, the length of hospital stay of children in autologous split-thickness skin group was significantly shortened (P<0.05), the length of hospital stay of children in combined skin grafting group was significantly prolonged (P<0.05). Compared with that in autologous split-thickness skin group, the length of hospital stay of children in combined skin grafting group was significantly prolonged (P<0.05). At the 6-month follow-up after wound healing, the total mVSS score of scars of children in debridement-alone group was 8.1±1.1, significantly higher than 6.8±0.9 in artificial dermis group (with mean difference of 1.3, 95% confidence interval of 0.8 to 1.8, P<0.05), and significantly lower than 9.4±1.5 in autologous split-thickness skin group (with mean difference of -1.3, 95% confidence interval of -1.8 to -0.8, P<0.05). Compared with that in artificial dermis group, the total mVSS score of children in autologous split-thickness skin group was significantly increased (with mean difference of -2.6, 95% confidence interval of -3.2 to -2.0, P<0.05). Compared with that in autologous split-thickness skin group, the 7.7±1.0 of total mVSS score of children in combined skin grafting group was significantly decreased (with mean difference of 1.7, 95% confidence interval of 1.1 to 2.3, P<0.05). Compared with that in debridement-alone group, the scar pliability score of children in artificial dermis group was significantly decreased (P<0.05). Compared with that in artificial dermis group, the scar pliability score of children in autologous split-thickness skin group was significantly increased (P<0.05). Compared with that in autologous split-thickness skin group, the scar pliability score of children in combined skin grafting group was significantly decreased (P<0.05). Conclusions Artificial dermis used for the repair of small to medium-sized deep partial-thickness scald wounds in infants and young children can improve scar quality, reduce the risk of wound infection, and relatively shorten wound healing time. It is particularly suitable for infants and young children whose aesthetic and functional outcomes are prioritized.
- Burns /
- Cicatrix /
- Artificial dermis /
- Infants and young children /
- Deep partial-thickness burns /
- Wound repair /
- Modified Vancouver scar scale /
- Curative effect
丁雄辉：研究设计、实施,数据采集和统计分析,论文撰写；肖军、李天武、毛小波：手术操作、研究实施；周荣：手术操作、数据分析；邱林：研究设计、实施及指导,论文指导及经费支持

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图 1 于清创术后采用人工真皮移植治疗患儿左前臂深Ⅱ度烫伤创面的效果。1A.左前臂深Ⅱ度创面采取湿性愈合措施治疗第7天,创面结痂且部分脱落,基底苍白；1B.创面于清创术后行人工真皮移植术后14 d情况；1C.创面愈合后1个月情况；1D.创面愈合后6个月随访时,瘢痕色素较图1C减退

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Table 1. 4组中小面积深Ⅱ度烫伤患儿一般资料比较

组别	例数	性别（例）		年龄（d,x¯±s）	创面面积（%TBSA,x¯±s）
组别	例数	男	女	年龄（d,x¯±s）	创面面积（%TBSA,x¯±s）
单纯清创组	55	35	20	513±198	7.4±2.1
人工真皮组	31	21	10	569±256	7.7±2.6
自体刃厚皮组	36	20	16	483±228	8.1±2.6
联合植皮组	27	20	7	495±158	7.8±2.7
统计量值		χ²=2.50		F=1.03	F=0.72
P值		0.476		0.381	0.540
注：单纯清创组患儿创面仅行清创术处理,人工真皮组、自体刃厚皮组、联合植皮组患儿创面于清创术后分别行人工真皮移植、自体刃厚皮移植、人工真皮联合自体刃厚皮移植；TBSA为体表总面积

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Table 2. 4组中小面积深Ⅱ度烫伤患儿创面愈合时间及住院时间比较（d,x¯±s）

组别	例数	创面愈合时间	住院时间
单纯清创组	55	29.2±6.5	22.5±4.6
人工真皮组	31	26.1±3.9	20.3±2.2
自体刃厚皮组	36	14.3±1.8	14.1±2.0
联合植皮组	27	24.4±1.6	23.9±1.2
F值		82.43	66.93
P值		<0.001	<0.001
P₁值		0.019	0.015
P₂值		<0.001	<0.001
P₃值		<0.001	0.349
P₄值		<0.001	<0.001
P₅值		0.759	<0.001
P₆值		<0.001	<0.001
注：单纯清创组患儿创面仅行清创术处理,人工真皮组、自体刃厚皮组、联合植皮组患儿创面于清创术后分别行人工真皮移植、自体刃厚皮移植、人工真皮联合自体刃厚皮移植；F值、P值为组间各指标总体比较所得；P₁值、P₂值、P₃值分别为人工真皮组、自体刃厚皮组、联合植皮组与单纯清创组比较所得；P₄值、P₅值分别为自体刃厚皮组、联合植皮组与人工真皮组比较所得；P₆值为自体刃厚皮组与联合植皮组比较所得

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Table 3. 4组中小面积深Ⅱ度烫伤患儿创面愈合后6个月随访时瘢痕mVSS评分比较（分,x¯±s）

组别	例数	总分	柔软度评分
单纯清创组	55	8.1±1.1	3.3±0.7
人工真皮组	31	6.8±0.9	2.7±0.7
自体刃厚皮组	36	9.4±1.5	3.7±1.0
联合植皮组	27	7.7±1.0	2.9±0.9
F值		28.32	10.43
P值		<0.001	<0.001
均数差值（95%置信区间）₁		1.3（0.8~1.8）	—
P₁值		<0.001	0.020
均数差值（95%置信区间）₂		-1.3（-1.8~-0.8）	—
P₂值		<0.001	0.175
均数差值（95%置信区间）₃		0.4（-0.1~1.0）	—
P₃值		0.893	0.317
均数差值（95%置信区间）₄		-2.6（-3.2~-2.0）	—
P₄值		<0.001	<0.001
均数差值（95%置信区间）₅		-0.9（-1.5~-0.3）	—
P₅值		0.240	>0.999
均数差值（95%置信区间）₆		1.7（1.1~2.3）	—
P₆值		<0.001	0.020
注：单纯清创组患儿创面仅行清创术处理,人工真皮组、自体刃厚皮组、联合植皮组患儿创面于清创术后分别行人工真皮移植、自体刃厚皮移植、人工真皮联合自体刃厚皮移植；mVSS为改良温哥华瘢痕量表；F值、P值为组间各指标总体比较所得；均数差值（95%置信区间）₁、P₁值,均数差值（95%置信区间）₂、P₂值,均数差值（95%置信区间）₃、P₃值分别为人工真皮组、自体刃厚皮组、联合植皮组与单纯清创组比较所得；均数差值（95%置信区间）₄、P₄值,均数差值（95%置信区间）₅、P₅值分别为自体刃厚皮组、联合植皮组与人工真皮组比较所得；均数差值（95%置信区间）₆、P₆值为自体刃厚皮组与联合植皮组比较所得；“—”表示无此项