刃厚头皮与异体脱细胞真皮基质复合移植修复特大面积烧伤患者手部深度创面  

Split-thickness scalp and allogenic acellular dermal matrix in repairing deep wounds of hands in patients with extremely extensive burns

作　　者：郭海雷[1] 凌翔伟[1] 刘政军[1] 徐建军 林才[1] 卢才教[1] Guo Hailei;Ling Xiangwei;Liu Zhengjun;Xu Jianjun;Lin Cai;Lu Caijiao(Department of Burns and Wound Center,the First Affiliated Hospital of Wenzhou Medical University Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院烧伤•伤口中心,325000

出　　处：《中华烧伤杂志》2019年第12期876-878,共3页Chinese Journal of Burns

摘　　要：目的探讨采用异体脱细胞真皮基质(ADM)联合刃厚头皮移植修复特大面积烧伤患者手部深度创面的临床效果。方法笔者单位2014年12月—2017年12月收治特大面积烧伤合并手深度烧伤患者6例,其中男4例、女2例,年龄21~58岁,烧伤总面积为85%~95%体表总面积(TBSA),深Ⅱ度和Ⅲ度创面之和均>50%TBSA。伤后4~6周在全身麻醉下,对10只手背侧深度创面采用大张刃厚头皮与异体ADM联合移植修复,植皮范围超过掌指关节,包括部分指背深度创面。观察记录手背创面植皮存活情况,手外形及功能恢复的随访情况。结果6例患者均救治成功。10只手背侧深度创面移植复合皮术后均存活良好,未出现感染。随访1~2年,愈合创面未反复形成张力性水疱,掌指关节无背伸畸形,手外形及功能恢复良好;Carroll手部功能评分90~99分,功能达Ⅴ、Ⅵ级。结论刃厚头皮与异体ADM联合移植是特大面积烧伤患者手部深度创面修复的良好方法,愈合创面瘢痕增生挛缩轻,手外形和功能恢复较佳。Objective To explore the clinical effects of split-thickness scalp and allogenic acellular dermal matrix(ADM)in repairing deep wounds of hands in patients with extremely extensive burns.Methods Six patients with extremely extensive burns complicated by deep burn in hands were admitted to our department from December 2014 to December 2017,including 4 males and 2 females,aged 21 to 58 years.Their total burn areas were from 85%to 95%total body surface area(TBSA),and the sum of deep-partial thickness and full-thickness wounds was larger than 50%TBSA.Under general anesthesia,deep wounds of 10 dorsal hands were repaired by combined transplantation of split-thickness scalp and allogenic ADM in 4 to 6 weeks after injury.The skin grafting range was beyond the metacarpophalangeal joint,including partial dorsal digital deep wounds.Survival of skin grafts on dorsal hands,follow-up of hand shape and functional recovery were observed and recorded.Results Six patients were successfully treated.There was no infection on the dorsal deep wounds of 10 hands after surgery,and the grafts survived well.During follow-up of 1 to 2 years after operation,there were no recurrent tension blisters or dorsal extension deformity of the metacarpophalangeal joints in 10 hands,the shape and function of hands recovered well,and hand Carroll scores were from 90 to 99 points,with functional levels ofⅤandⅥ.Conclusions The combined transplantation of split-thickness scalp and allogenic ADM is a good method for repairing deep hand wounds in patients with extremely extensive burns,which can alleviate the cicatrix hyperplasia and contracture of healed hand wounds,and improve the shape and function of hands.

关 键 词：烧伤 手 头皮 瘢痕 脱细胞真皮基质 

分 类 号：R47[医药卫生—护理学]