改良足底皮片移植法修复背臀部深度烧伤创面的疗效  

Therapeutic effects of modified plantar skin grafting for the deep burn wounds of the back and butts

作　　者：黄书润[1] 林慧[2] 曾纯 刘江涛 叶维奇 王一勇 苏惠强 Huang Shurun;Lin Hui;Zeng Chun;Liu Jiangtao;Ye Weiqi;Wang Yiyong;Su Huiqiang(Department of Burns and Plastic Surgery,910th Hospital of Joint Logistic Support of PLA,Quanzhou 362000,China;Department of Pathology,910th Hospital of Joint Logistic Support of PLA,Quanzhou 362000,China)

机构地区：[1]中国人民解放军联勤保障部队第九一〇医院烧伤整形科,泉州362000 [2]中国人民解放军联勤保障部队第九一〇医院病理科,泉州362000

出　　处：《中华创伤杂志》2024年第3期243-249,共7页Chinese Journal of Trauma

基　　金：福建省自然科学基金面上项目(2023J1241)。

摘　　要：目的比较改良足底皮片移植法和大腿皮片修复背臀部深度烧伤创面的效果。方法采用回顾性队列研究分析2021年1月至2023年4月中国人民解放军联勤保障部队第九一〇医院收治的30例背臀部深度烧伤创面患者的临床资料,其中男26例,女4例;年龄21~72岁[(49.9±14.0)岁]。烧伤总面积占50%~97%总体表面积(TBSA),背臀部Ⅲ度烧伤面积占6%~16%TBSA。背臀部创面仅采用足底或大腿皮片修复或足底皮片联合其他部位皮片修复。按取皮部位及次数分组:20例为足底取皮,其中10例足底取1次皮(足底单次取皮组)和10例足底取2~3次皮(足底反复取皮组);10例大腿取1次皮(大腿单次取皮组)。计算足底取皮患者末次取皮面积、每次可修复的背臀部创面面积。末次取皮后,足底单次取皮组分别与大腿单次取皮组、足底反复取皮组的皮片角质层厚度、7 d皮片成活率、3个月植皮区残余创面面积占比、供区愈合时间、6个月供区温哥华瘢痕评分(VSS)进行比较。末次取皮后6个月,观察植皮区外观质地、患者行走情况及并发症发生情况。结果患者均获随访6~18个月[(7.8±1.6)个月]。20例足底取皮患者中,末次取皮面积为2.5%~4.5%TBSA[(3.4±0.6)%TBSA],每次可修复的背臀部创面面积为3%~8%TBSA[(5.5±1.5)%TBSA]。末次取皮后,足底单次取皮组皮片角质层厚度为(190.4±8.9)μm,较大腿单次取皮组的(50.0±6.6)μm和足底反复取皮组的(166.8±21.9)μm厚(P<0.01);7 d皮片成活率、3个月背臀部植皮区残余创面面积占比、供区愈合时间、6个月供区VSS足底单次取皮组分别为(93.6±2.3)%、2.0(0.1,3.5)%、(9.9±1.8)d、(1.7±0.7)分,大腿单次取皮组分别为(78.0±6.6)%、5.3(4.0,5.8)%、(14.0±1.4)d、(4.9±2.3)分,足底反复取皮组分别为(93.4±2.6)%、2.0(0.1,3.8)%、(10.0±1.2)d、(1.8±0.8)分;足底单次取皮组7 d皮片成活率高于大腿单次取皮组,3个月植皮区残余创面面积占比、供区愈�Objective To compare the therapeutic effects of modified plantar skin grafting and thigh skin grafting on the deep burn wounds of the back and buttocks.Methods A retrospective cohort study was conducted to analyze the clinical data of 30 patients with deep burn wounds on their back and buttocks who were admitted to the 910th Hospital of Joint Logistic Support Force of PLA from January 2021 to April 2023,including 26 males and 4 females,aged 21⁃72 years[(49.9±14.0)years].The total burn size was 50%⁃97%of the total body surface area(TBSA),with the third⁃degree burn on the back and buttocks 6%⁃16%TBSA.The burn wounds on the back and buttocks were repaired using plantar skin grafts alone,thigh skin grafts alone or plantar skin grafts combined with the grafts from other body parts.The patients were grouped according to the skin graft donor sites and the times of harvesting skin grafts:there were 20 patients undergone plantar skin grafting including 10 patient with plantar skin graft harvested once(group of plantar skin graft harvested once)and 10 patients with plantar skin graft harvested twice or three times(group of plantar skin graft harvested more than once),and 10 patients undergone thigh skin grafting harvested once(group of thigh skin graft harvested once).The areas of plantar skin grafts harvested at the last time and the wound areas on the back and butts that could be repaired each time were calculated.After the last harvest,the thickness of the stratum corneum,7⁃day survival rate of the skin grafts,proportion of 3⁃month residual wound area in the skin graft area,healing time of the donor sites,and 6⁃month Vancouver Scar Scale(VSS)scores of the donor sites in the group of plantar skin graft harvested once were compared with those in the group of thigh skin graft harvested once and the group of plantar skin graft harvested more than once.The appearance and texture of the skin graft,patients′walking patterns and complications were observed at 6 months after the last skin harvest.Results All the

关 键 词：烧伤 背 臀 足底皮肤移植 

分 类 号：R644[医药卫生—外科学]