封闭式负压引流技术治疗保留变性真皮薄层削痂植皮的手部深Ⅱ度烧伤  

Thinning tangential excision combined with vacuum sealing drainage in repair of deeply partial thickness burn of hands with the preservation of denatured dermis and auto-skin grafting

作　　者：张郑[1] 张汝敏[1] 

机构地区：[1]淄博市中心医院烧伤整形科,山东255036

出　　处：《中国急救复苏与灾害医学杂志》2012年第10期933-937,共5页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的探讨薄层削痂保留变性真皮自体皮移植后联合VSD技术修复手部深Ⅱ度烧伤的可行性。方法对收治的90例双手深Ⅱ烧伤患者，随机分为两组，一组薄层削痂保留变性真皮植皮后联合VSD技术治疗组45例，另一组传统清创削痂植皮对照组45例。对两组术中失血量、皮片成活率、创面愈合时间、创面感染情况、外形与功能优良率进行统计学分析，对此两种方法进行评价。结果治疗组与对照组比较，治疗组术中失血量少（P〈0．05）、皮片成活率高（P〈0．05）、创面愈合时间短（P〈0．05）、创面感染等并发症发生少（P〈0．01）、外形与功能优良满意（P〈0．01）。结论薄层削痂保留变性真皮自体皮移植修复手部深Ⅱ度烧伤可作为手深度烧伤微创治疗的常规术式，能最大限度修复手的外形与功能。结合VSD技术可有效清除创面坏死组织，减少植皮创面感染等并发症，促进植皮创面的愈合，缩短疗程，减轻换药痛苦，是一种理想的植皮后的固定方法，值得临床推广应用。Objective To study the feasibility of thinning tangential excision combined with vacuum sealing drainage in repair of deeply partial thickness burn of hand with the preservation of denatured dermis and auto-skin grafting. Methods 90 deeply partial thickness burn of hands burned patients were randomly divided into two groups - thinning tangential excision group of which the wounds were treated by thinning tangential excision combined with vacuum sealing drainage and grafted with auto-skin with the preservation of denatured dermis and traditional tangential excision group of which the burned hands were treated by traditional tangential excision and auto-skin graft for contrast. Therapeutic efficacy between the two groups were compared on intra-operative blood loss, the survival rate of the skin graft, the healing time of wounds, the infection rate and the external features and the functional restoration of hands. Results Between the thinning tangential excision group and the traditional tangential excision group in intra-operative blood loss, survival rate of the skin graft and the healing time, there was significant difference （P〈O.05）, and so was in the infection rate, the external features and the functional restoration of hands （P〈0.01）. Conclusion The preservation of denatured dermis by thinning tangential excision and auto-skin grafting are considered as an effective routine and minimal invasive method in treating deeply partial thickness burned hands. The VSD （vacuum sealing drainage） technique is considered as an ideal anchorred method after skin grafting that may efficiently reduce the complication heal the wound, short the therapeutic time. The method is recommended for clinical practice.

关 键 词：烧伤 手 负压封闭引流 削痂术 皮肤移植 变性真皮 

分 类 号：R323[医药卫生—人体解剖和组织胚胎学]