二茬头皮在大面积深烧伤手术中的应用  

Second layer of scalp in the treatment of excised severe burn wounds

作　　者：鲁延林[1] 张悦安[1] 徐旭[1] 陈万安[1] 朱志祥[1] 

机构地区：[1]深圳市第二人民医院,广东深圳518035

出　　处：《临床医药实践》2006年第9期650-652,共3页Proceeding of Clinical Medicine

摘　　要：目的：观察二茬头皮在大面积深烧伤手术中的应用效果。方法：对大面积烧伤需要手术切痂头皮移植的思者，常规用电动或气动取皮刀在头部连续切取两层表皮，厚度0．07～0．12mm。将两层表皮制作成小邮票皮，规格为3mm×3mm，间隔3mm移植。外层以异体皮移植。供皮区和移植区创面喷涂表重组人表皮生长因子外用溶液。头皮创面加压包扎，第二天打开敷料，创面半暴露，以红外线灯烤，以表重组人表皮生长因子外用溶液局部喷湿创面，每日1次，约每10cm×10cm面积4000IU，同时皮下注射重组生长激素10U，每日2次，5d为1个疗程。3～10d头皮长好，就行下一次手术。结果：共13例患者97个部位．烧伤面积最小70％，最大94％，平均（83．92±6．65）％，均为大面积深烧伤患者，其中深二度平均（33．46±23．03）％，三度平均（47．16±24．20）％，进行了手术。每次头皮供皮面积3．5％，表层以及二茬皮实际提供7％的皮肤，可覆盖面积30％～40％。术后观察小邮票皮98％～100%成活。3～10d头皮长好，每例患者手术3～8次，愈合时间最短28d，最长54d，平均（36．31±12．99）d。6个月后头部皮肤供区7例毛发生长如伤前，1例稀疏，系取皮过厚所致；早期进行综合抗瘢痕治疗，外观满意。结论：二茬头皮在大面积深烧伤手术中的应用效果满意。Objective：To evaluate the effect of second layer of scalp in the repair of excised severe burn wounds. Methods：The donor sites of two layer of scalp epidermis were grafted,of the thickness about 0.07～0.12 mm,harvested by electric or air dermatome and of the interval about 3 mm, 3 mm×3 mm stamp size free skin grafting,outside which were covered with homograft. The donor and the transplant area were spouted with rhEFG at the level of 4000 IU/10 cm × 10 cm. The head wound were wrapped with pressure and changed dressing the second day,leaving which semi-exposed,roasted by infrared light and spouted with rhEFG qd. The patients were injected with recombinant human growth hormone（10 U ,bid ,i. h. ）,of which one treatment period was 5 days. Another operation was done as soon as the scalp recovered in 3～10 days. Results：This method was used in a total of 97 donor sites of 13 patients from May 2002 to November 2005,whose TBSA was from 70 %to 94% and whose mean TBSA was （83.92±6.65）%. Operation were done on these severe burned patients whose mean deep two degree were （33.46±23.03）% and whose mean three degree were（47.16±24.20）%. The first and second layer of scalp could supply 7% skin and could cover 30%～40%surface of the body. 98%～100% stamp size freeskin made from the second layer of the scalp survived and the donor sites healed good enough 3～10 days after the operation. All the burn wound cicatrized in 28～54 days. With the average of （36.31±12.99） days. Of the 13 eases 12 regained normal hair and 1 had sparseness hair 6 month later because of too thick skin cutting and satisfied appearance was obtained with the anti-scar treatment. Conclusions ：Second layer of scalp is useful in the repair of excised severe burn wounds.

关 键 词：头皮 烧伤 手术 

分 类 号：R644[医药卫生—外科学]