人工真皮联合碱性成纤维细胞生长因子在瘢痕和皮肤深度创面整复中的临床应用  

Clinical application of artificial dermis combined with basic fibroblast growth factor in the treatment of cicatrix and deep skin wounds

作　　者：刘洋[1] 张宜澜[1] 黄亚兰[1] 罗高兴[1] 彭毅志[1] 颜洪[1] 罗奇志[1] 张家平[1] 吴军[1] 彭代智[1] 

机构地区：[1]第三军医大学西南医院全军烧伤研究所,创伤、烧伤与复合伤国家重点实验室,重庆400038

出　　处：《中华烧伤杂志》2016年第4期198-203,共6页Chinese Journal of Burns

摘　　要：目的观察人工真皮联合bFGF应用于瘢痕和皮肤深度创面整复的临床效果。方法回顾性分析2010年10月-2015年4月笔者单位收治的符合人选标准的应用人工真皮修复创面的72例患者临床资料，创面类型为瘢痕切除后创面、无肌腱或骨外露深度烧伤创面、小面积肌腱或骨外露创面，共102个创面。根据是否联合应用bFGF，将创面分为人工真皮组60个和人工真皮＋bFGF组42个。人工真皮组I期手术行瘢痕松解和切除或深度创面彻底清创，移植人工真皮，待人工真皮血管化完成时，行Ⅱ期手术移植自体刃厚皮修复创面。人工真皮＋bFGF组的人工真皮先用bFGF浸泡30min后再移植，其余手术方法同人工真皮组。统计2组创面手术面积、人工真皮完全血管化时间、皮片存活情况及随访情况。对数据行t检验、Fisher确切概率法检验。结果（1）2组创面中瘢痕切除后、无肌腱或骨外露深度烧伤、小面积肌腱或骨外露创面手术面积相近（t值为-1．853～-0．200，P值均大于0．05）。人工真皮＋bFGF组创面中瘢痕切除后、无肌腱或骨外露深度烧伤、小面积肌腱或骨外露创面人工真皮完全血管化时间分别为（15．6±2．9）、（14．7±2．7）、（20．3±4．g）d，较人工真皮组相应创面的（18．3±4．7）、（18．7±4．2）、（27．7±8．8）d平均分别缩短2．7、4．0、7．4d（t值为-2．779～-2．383，P值均小于0．05）。（2）人工真皮＋bFGF组3种类型创面中，相同类型创面皮片存活为优者所占比例均高于人工真皮组，但差异无统计学意义（P值均大于0．05）。（3）术后随访1～48个月，2组创面植皮区和供皮区均无明显瘢痕生长。结论人工真皮联合bFGF能有效缩短人工真皮在瘢痕切除后创面和皮肤深度创面的血管化时间。Objective To observe the effects of artificial dermis combined with basic fibroblast growth factor （bFGF） on the treatment of cicatrix and deep skin wounds. Methods The clinical data of 72 patients with wounds repaired with artificial dermis, hospitalized in our unit from October 2010 to April 2015, conforming to the study criteria, were retrospectively analyzed. The types of wounds were wounds after resection of cicatrices, deep burn wounds without exposure of tendon or bone, and wounds with exposure of small area of tendon or bone, in a total number of 102. Wounds were divided into artificial dermis group （A, n = 60） and artificial dermis ＋ bFGF group （ B, n = 42） according to whether or not artificial dermis combined with bFGF. In group A, after release and resection of cicatrices or thorough debridement of deep skin wounds, artificial dermis was directly grafted to wounds in the first stage operation. After complete vaseularization of artificial dermis, wounds were repaired with autologous split-thickness skin grafts in the sec- ond stage operation. In group B, all the procedures were exactly the same as those in group A except that artificial dermis had been soaked in bFGF for 30 min before grafting. Operation area, complete vascularization time of artificial dermis, survival of skin grafts, and the follow-up condition of wounds in the two groups were recorded. Data were processed with t test and Fisher＇s exact test. Results （ 1 ） Operation areas of wounds after resection of cicatrices, deep burn wounds without exposure of tendon or bone, and wounds with exposure of small area of tendon or bone in the two groups were about the same （with t values from - 1. 853 to - 0. 200, P values above 0.05）. Complete vascularization time of artificial dermis in wounds after resection of cicatrices, deep burn wounds without exposure of tendon or bone, and wounds with exposure of small area of tendon or bone in group B were respectively （15.6±2.9）, （14.7 ±2.7）, and （20.3±4.4） d, and t

关 键 词：瘢痕 烧伤 伤口愈合 真皮 成纤维细胞生长因子 新生血管化 生理性 深度皮肤创面 

分 类 号：R64[医药卫生—外科学]