一例大面积特重度烧伤的救治及后期畸形修复  

Management of a patient with massive and deep burns： early care and reconstruction after convalescence

作　　者：陈璧[1] 胡大海[1] 贾赤宇[2] 丁国斌[3] 姚庆君[1] 刘亚玲[1] 

机构地区：[1]第四军医大学西京医院全军烧伤中心,西安710032 [2]解放军总医院第一附属医院全军烧伤研究所 [3]成都军区拉萨总医院烧伤科

出　　处：《中华烧伤杂志》2007年第2期112-116,共5页Chinese Journal of Burns

摘　　要：目的 探寻特重度烧伤后早期救治及后期畸形修复、功能重建的新措施。方法 对1例火焰烧伤总面积99．5％TBSA（Ⅲ度80．0％、深Ⅱ～Ⅲ度混合度14．5％、浅Ⅱ度5.0％）合并高钠、高氯血症的患者，入院后及早切痂，用异体皮覆盖创面；因自体皮源奇缺，根据皮源量分次移植自体皮或异体皮封闭创面。晚期采用瘢痕皮、瘢痕瓣、复合皮移植修复30多处瘢痕挛缩畸形。结果 患者伤后早期经上述治疗病情逐渐稳定，未发生明显的并发症，手术7次，历时106d，创面完全愈合。晚期进行15次整形手术，各部位功能均恢复良好，容貌得以改善。伤后26个月患者完全康复，重返工作岗位。结论 对自体皮源奇缺的大面积烧伤患者，早期切痂用异体皮覆盖创面，待有少量自体皮源时分次行微粒皮移植，可稳定病情，减少并发症；溶痂创面用异体皮覆盖，可保护未受损的皮肤附件细胞，促进再上皮化，有利于创面及早愈合。晚期采用瘢痕皮、瘢痕瓣及复合皮进行畸形修复，能达到重建功能的目的。Objective To seek ideal strategies in saving a patient with very extensive deep burns, and measures for functional reconstruction after convalescence. Methods A patient with 99.5% TBSA flame burn injury （ Ⅲ° 80%, deep second degree 14.5% and superficial Ⅱ° 5% ） , complicated with hypernatremia and hyperchloraemia was admitted 76 hours after the injury. Early escharectomy and alloskin grafting were performed. Because of the lack of autoskin donor site, the skin grafting of autologous skin was only undertaken whenever there was an available source, and the remaining wounds were temporarily covered with allografts. Finally the patient survived. After healing of all the wounds, contractures were corrected with skin from scars, flaps of scarred skin or composite skin, and more than 30 cicatricial contracture deformities were corrected after convalescence. Results After initial treatments and extensive early escharectomy, the patient＇s condition became stable gradually, without adverse complications. After 7 operations, the wounds finally healed completely after 106 days. The function of all joints were restored well and external appearance improved after 15 plastic and reconstructive operations during convalescence period. The patient was fully rehabilitated and resumed his original work 26 months after the injury. Conclusion For those patients with massive burns and short of donor site, alloskin grafting after early escharectomy, and persistent repeated microskin grafting whenever any small amounts of own skin is available, is essential to stabilize the patients＇ condition, and reduce complications. Covering the wounds as the result of shedding off of eschar with alloskin can protect the undamaged cells in skin appendages to promote re-epithelization and wound healing. It is feasible to harvest skin grafts from scars, and use scar skin flaps and composite skin to repair contractures after convalescence with good outcome in function and external appearance.

关 键 词：烧伤 瘢痕 挛缩 畸形 皮肤移植 

分 类 号：R686[医药卫生—骨科学]