改良自体中厚皮片在修复功能部位深度烧伤创面中的应用  

A Modified Technique of Split-thickness Skin Grafts for Repair of Deep Wounds in Functional Location Caused by Burn

作　　者：邝江波 王永飞[2] 谭成波[2] 许喜生[2] KUANG Jiangbo;WANG Yongfei;TAN Chengbo;XU Xisheng(Department of Emergency Medicine,the First People’s Hospital of Chenzhou,Chenzhou 423000,Hunan,China;Department of Burn and Plastic Surgery,the First People’s Hospital of Chenzhou,Chenzhou 423000,Hunan,China)

机构地区：[1]郴州市第一人民医院急诊科,湖南郴州423000 [2]郴州市第一人民医院烧伤整形外科,湖南郴州423000

出　　处：《中国美容医学》2023年第2期39-42,共4页Chinese Journal of Aesthetic Medicine

摘　　要：目的:探索一种简单、实用、有效的自体中厚皮片处理方法,以应用于修复功能部位深度烧伤创面。方法:选取2020年6月-2021年6月笔者医院烧伤整形外科收治的功能部位深度烧伤患者64例,采用随机数字表法将其分为观察组(n=32)和对照组(n=32)。术中观察组将所取皮片用15G针头每间隔0.5~1 cm处打一个小孔备用,便于引流,对照组所取皮片不进行打孔处理,将自体中厚皮片直接覆盖于准备好的创面上,予以常规加压包扎。术后7 d植皮术区换药,打开敷料,观察并计算皮片成活率,比较两组术后第1天、第7天、第14天视觉模拟评分表(Visual analogue scale,VAS)、创面愈合时间、住院时间情况。采用温哥华瘢痕量表(Vancouverscarscale,VSS)评价术后6~12个月的临床效果。数据采用两独立样本t检验、Cochran&Cox近似t检验、χ^(2)检验、Fisher确切概率法检验,以P<0.05表示差异有统计学意义。结果:两组的VAS评分随着时间的推移均呈下降趋势,组间比较疼痛程度无明显差异(P>0.05);针头穿刺打孔组皮片成活率明显高于对照组成活率(P<0.05);观察组创面愈合时间及住院时间较对照组创面愈合时间及住院时间缩短(P<0.05);术后随访6~12个月,两组间VSS评分无显著差异(P>0.05)。结论:针头穿刺打孔改良处理自体中厚皮能有效提高皮片成活率,缩短住院时间,不增加术区瘢痕增生,操作简单,值得临床推广。Objective To explore a simple and practical method of autologous thick skin transplantation for repairing deep burn wounds in functional site.Methods From June 2020 to June 2021 Sixty-four patients with deep burn wounds at functional site were divided into observation group(n=32)and control group(n=32)according to the random number table method.During the operation the skin was drilling a holes every 0.5-1cm by the 15G needle for the observation group,while the skin was directly covered the prepared raw surface,then the wounds were packed properly and treated by dressing change for the control group.The bandage was opened during the first dressing change on the 7th day after surgery.The skin graft surviving area and proportion,visual analogue scale(VAS),Wound healing time,vancouver scar scale(VSS),hospital stay after operation were observed and calculated.The data were statistically analyzed with two independent sample t test,Cochran&Cox approximate t test,chi-square test,and Fisher’s exact probability test.Results There was no significant difference in pain degree between the two groups(P>0.05).The skin survival rate of the observation group was significantly higher than that of control group(P<0.05).The wound healing time,and postoperative length of hospital stay in observation group was significantly less than that in control group(P<0.05).There was no significant difference in vancouver scar scale(VSS)between the two groups(P>0.05).Conclusion The method can effectively promote wound healing,improve the survival rate of skin grafting,shorten the length of hospital stay,which is worth generalizing and applying.

关 键 词：烧伤 功能部位 中厚皮片 创面修复 皮肤移植 瘢痕 

分 类 号：R622[医药卫生—整形外科]