用大片自体皮移植治疗大面积Ⅲ°烧伤提高患者生活质量  

Better life quality: Large sheet thin and/or split thickness skin autografting in the treatment of extensive third degree burn victims

作　　者：陈璧[1] 贾赤宇[1] 苏映军[1] 徐明达[1] 胡大海[1] 朱雄翔[1] 

机构地区：[1]第四军医大学西京医院整形外科中心烧伤外科

出　　处：《第四军医大学学报》1999年第5期420-422,共3页Journal of the Fourth Military Medical University

摘　　要：目的：探讨大片自体皮移植对减轻大面积Ⅲ°烧伤患者治愈后的畸形和功能障碍，提高患者生活质量的疗效．方法：将早期救治与后期的整形、重建、功能与美容修复融为一体的外科治疗方法．在患者全身情况允许时，伤后１ｗｋ～２ｗｋ行切痂或削痂，作大片自体皮移植．为扩大皮源，我们创用了在同一供皮区和Ⅱ°烧伤初愈区重复大片供皮（刃厚皮片）的技术．结果：１９８０年至今，４５例烧伤总面积５０％～８０％，Ⅲ°烧伤２０％～５０％的患者，采用上述治疗，全部存活，皮片存活率为９０％～１００％．随访３９例（３ｍｏ～１５ａ），３５例植皮区外形接近正常，功能良好，４例患者有轻度畸形，并采用小手术得到修复．结论：改进取皮技术，扩大皮源，采用大片自体皮移植，皮片存活率高，明显缩短了疗程，功能与外形好．对烧伤总面积５０％～８０％，Ⅲ°烧伤２０％～５０％的患者能显示其提高患者治愈后生活质量的优越性．AIM: Large sheet thin and/or split thickness skin autografting was used in the treatment of extensive Ⅲ degree burn victims to improve their life quality by mitigating deformities and dysfunctions. METHODS: Early and proper treatment was followed by plastic reconstructive surgery, with a consideration of both functional and aesthetic restoration. Providing the patients′ condition permitted, the first time escharectomy and/or tangential eschar excision were performed about 1 wk￣2 wk postburn, which was followed by large sheet skin autografting, about 25% of TBSA. In order to expand the skin donor sources, a special technique had been established to harvest large sheet thin and/or split thickness skin grafts repeatedly from the same donor site, and the preliminary healing surface of Ⅱ degree burn area was used as skin donor too. RESULTS: 45 victims, with burns of 50%￣80% of TBSA including 20%￣ 50% Ⅲ degree burns, had been treated and all survived since 1980. The ‘take’ of skin grafts was 90%￣100%. Long term follow up (3 mo￣15 a) in 39 patients revealed that 35 cases showed good functional and aesthetic results and the grafted skin looked like normal skin. 4 cases had mild deformities, which were restored by minor repair. CONCLUSION: This treatment can shorten the therapeutic course, achieve high ‘take’ percentage of the skin grafts with good functional and aesthetic results, and improve the life quality of patients with burns of 50%￣80% of the TBSA including 20%￣ 50% Ⅲ degree burns.

关 键 词：烧伤 治疗 皮肤移植 移植 自体 

分 类 号：R644.05[医药卫生—外科学] R622.1[医药卫生—临床医学]