保留变性真皮二期植皮法治疗四肢关节部位深Ⅱ度烧伤的临床效果  

Clinical effects of two-stage skin grafting with retained denatured dermis in the treatment of deep second-degree burns in joints of the extremities

作　　者：马丽 潘孙峰 王振君 方高丰 朱敏达 胡衍泽 王晶 MA Li;PAN Sunfeng;WANG Zhenjun;FANG Gaofeng;ZHU Minda;HU Yanze;WANG Jing(Fourth Clinical Medical College,Zhejiang Chinese Medical University,Hangzhou 310053,China;不详)

机构地区：[1]浙江中医药大学第四临床医学院,310053 [2]浙江中医药大学附属嘉兴中医院烧伤整形科 [3]浙江中医药大学附属嘉兴中医院病理科

出　　处：《浙江医学》2023年第4期399-403,共5页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2020PY075);嘉兴市科技计划项目-民生科技创新(2019AY32017)。

摘　　要：目的探讨四肢关节部位深Ⅱ度烧伤早期削痂、保留变性真皮联合负压封闭引流(VSD)治疗后二期移植刃厚皮片的临床疗效。方法采用回顾性研究,选择2018年1月至2021年3月浙江省中医药大学附属嘉兴中医院收治的26例四肢关节部位深Ⅱ度烧伤患者(共31个创面),受伤至入院时间(7.3±3.1)h,烧伤面积1%~7%总体表面积(TBSA)。早期削痂保留变性真皮联合VSD治疗4~5 d,二期行刃厚皮片移植术。观察保留变性真皮VSD治疗前后组织病理学结果,观察治疗期间植皮区有无积液、血肿、感染及皮片坏死情况,记录供植皮区完全由上皮组织覆盖、无渗液的愈合时间。随访半年,观察植皮区有无附件炎发生,采用温哥华瘢痕评定量表(VSS)、患者与观察者瘢痕评估量表(POSAS)对供植皮区瘢痕情况进行评分。结果保留变性真皮联合VSD治疗前真皮层少量胶原纤维玻璃样变性,可见炎症细胞浸润带,治疗后真皮层胶原纤维增生并玻璃样变性、炎症细胞浸润带基本消失。26个供皮区创面均一期愈合,愈合时间为(9.61±1.83)d。31个植皮区创面愈合时间为(13.35±1.56)d,无血肿、感染、皮片坏死发生,其中29个创面一期愈合,2个创面出现皮下积液,经引流换药愈合。随访6个月,26个供皮区VSS评分为1(1,2)分,患者对供皮区瘢痕总体评价为2.00(1.00,2.25)分;31个植皮区瘢痕无附件炎发生,VSS评分为(3.39±2.28)分,医生对植皮区瘢痕总体评价为(3.48±1.20)分,无因功能活动受限而行瘢痕整形手术发生。结论早期削痂保留变性真皮联合VSD治疗后二期行刃厚皮片移植应用于四肢关节部位深Ⅱ度烧伤,能有效保护间生态组织、减轻进行性损伤,保证关节部位愈合质量的同时减少供区损伤,具有临床推广应用价值。Objective To investigate the clinical effect of early tangential excision and preservation of denatured dermis combined with vacuum sealing drainage(VSD)in the treatment of deep second-degree burns in joints of the extremities.Methods A retrospective study was carried out from January 2018 to March 2021,26 patients of deep seconddegree burns in joints of the extremities with 31 wounds were admitted to Zhejiang Chinese Medicine University Affiliated Jiaxing TCM Hospital,the average hospitalization time after injury was(7.3±3.1)hours,and the burn area ranged from 1%~7%of total body surface area(TBSA).Early tangential excision and preservation of denatured dermis combined with VSD for 4~5 days,followed by the second-stage slpit thickness skin grafting,the histopathological results of preserved denatured dermal VSD were observed before and after treatment,and the situation of hydrops,hematoma,infection and skin necrosis in the skin graft area during treatment were also observed.Additionally,the healing time of the skin graft area completely covered by epithelial tissue and without seepage were recorded.The patients were followed up for 6 months to observe the incidence of adnexitis in the skin graft area,and the Vancouver Scar Rating Scale(VSS)alone with the patient-observer Scar Rating Scale(POSAS)were used to evaluate the scar condition in the skin graft area.Results It showed that there was a small amount of collagen Hyaline in the dermis before VSD treatment,the dermal collagen fibers proliferated and the infiltration bands of hyaline and inflammatory cell disappeared after VSD treatment.All the wounds in 26 donor sites healed in the first stage,and the healing time was(9.61±1.83)d.No hematoma,infection or skin necrosis occurred in 31 skin grafting areas,the healing time was(13.35±1.56)days,no hematoma,infection and skin graft necrosis occurred.29 of the 31 skin wounds healed in the first stage,2 wounds of the 31 skin grafting areas had subcutaneous effusion,and healed after drainage and dressing change.During

关 键 词：削痂 变性真皮 负压封闭引流术 深Ⅱ度烧伤 关节部位创面 瘢痕 

分 类 号：R644[医药卫生—外科学]