中、小面积深度烧伤符合功能与美学要求的皮肤移植术  

Skin grafting of middle and small area deep burn wounds for functional and aesthetic recovery

作　　者：朱雄翔[1] 胡大海[1] 韩军涛[1] 郑朝[1] 陶克[1] 王洪涛[1] 陈璧[1] 

机构地区：[1]第四军医大学西京医院全军烧伤中心,陕西西安710033

出　　处：《第四军医大学学报》2007年第13期1205-1207,共3页Journal of the Fourth Military Medical University

摘　　要：目的:探讨非面颈部中、小面积深度烧伤更加符合人体皮肤功能与美学要求的皮肤移植技术.方法:受皮区创面采用浅切痂、削痂法,尽可能多保留创面正常皮下组织,严密止血.以低浓度肾上腺素生理盐水皮下注射肿胀供皮区,鼓式取皮机、电动切皮机或滚轴取皮刀切取厚0.2～0.6mm大张中厚断层皮;游离皮片长轴垂直于受区纵轴不开洞移植.皮片与创缘、皮片与皮片3-0丝线严密缝合,妥善包扎、制动.结果:接受改进的皮肤移植术的患者共592例,受区面积为1%～30%[平均(11.2±2.7)%]TBSA.全部病例移植皮片成活率>95%,移植皮片100%成活者91.9%(544/592),随访1a以上评价,受区皮肤组织丰满,质地柔软、光滑,无明显增生性瘢痕,肢体关节活动自如,轻度色素沉着,供皮区表面较正常皮肤略粗糙,色素沉着不明显.结论:加强创面处理,改进和熟练掌握取皮技术,选择合适供区,中、小面积深度烧伤采用大张中厚和薄中厚断层皮不开洞移植,供皮区和修复部位均获得较理想的功能与美容效果.AIM： To discuss the skin grafting of middle and small area deep noncervicofacial burns for optimal functional and aesthetic results. METHODS： Superficial escharectomy and eschar tangential excision were adopted for the treatment of burn wounds in the recipient sites, with normal subdermal tissues remained as much as possible and bleeding prevented tightly. Turgidization was performed by hypodermic injection of normal saline solution with low concentration of adrenaline in the donor sites. A large sheet of split-thickness skin graft （0.2 -0.6 mm） was usually harvested with a Padgett dermatome, electric dermatome or free hand knife. Long axis of skin sheet was vertically laid down to the longitudinal axis of wound and the grafting was carried out without hole opened and with 3-0 silk suture. Finally, the wounds were dressed and fixed. RESULTS： The skin grafting was performed in altogether 592 cases, with recipient area of 1% - 30% TBSA and average of （ 11.2 ± 2.7 ） % TBSA. Survival rate of transplanted skin sheets on all patients was more than 95% and the cases with 100% survival of transplanted skin accounted for 91.9% of all cases. 1 -year or longer follow-up results were as follows： skin tissue in recipient site appeared full, soft and smooth with slight pigmentation, but without obvious hypertrophic scar; the limb joints could freely move; surface of skin donor sites showed a little more coarse than that of normal skin, with obscure pigment deposition. CONCLUSION： By strengthening wound management, improving and proficiently grasping skin harvesting technology, selecting suitable donor site, we could obtain an ideal functional and aesthetic results for both donor and recipient sites in the transplantation of a large sheet of thicker or thin split skin graft without hole opened for middle to small area deep burn.

关 键 词：烧伤 皮肤移植 功能 美学 

分 类 号：R622.1[医药卫生—整形外科]