复合皮移植结合系统康复治疗儿童烧伤后腘窝周围大范围瘢痕挛缩畸形的临床效果  

Clinical application of composite skin transplantation combined with systemic rehabilitation in the treatment of extensive scar contracture around the popliteal fossa in children after burns

作　　者：计鹏 郑朝 曹涛 张智 赵海洋 田晨阳 梁敏 胡大海 陶克 Ji Peng;Zheng Chao;Cao Tao;Zhang Zhi;Zhao Haiyang;Tian Chenyang;Liang Min;Hu Dahai;Tao Ke(Department of Burns and Cutaneous Surgery,Burns Center of PLA,the First Affiliated Hospital of Air Force Military Medical University,Xi′an 710032,China;Department of Wound Repair and Regenerative Medicine Center,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325015,China)

机构地区：[1]空军军医大学第一附属医院全军烧伤中心,烧伤与皮肤外科,西安710032 [2]温州医科大学附属第一医院创面修复与再生医学中心创面修复科,温州325015

出　　处：《中国医师杂志》2024年第3期326-330,共5页Journal of Chinese Physician

基　　金：国家自然科学项目(82272269)。

摘　　要：目的探讨应用复合皮移植结合系统康复治疗儿童烧伤后腘窝周围大范围瘢痕挛缩畸形的临床效果。方法采用回顾性观察性研究方法。选取2018年3月至2022年4月空军军医大学第一附属医院收治的17例符合入选标准的烧伤后腘窝周围大范围瘢痕挛缩畸形患儿,其中男10例、女7例,年龄2~11岁,瘢痕挛缩畸形病程10个月至9年,瘢痕均位于腘窝周围,右侧腘窝10例,左侧腘窝5例,双侧腘窝2例,腘窝周围瘢痕导致膝关节伸直角度仅为95°~115°。术中彻底松解瘢痕挛缩,恢复关节活动度,并形成继发创面范围10 cm×8 cm~20 cm×13 cm,Ⅰ期术中彻底松解瘢痕挛缩后,创面覆盖负压封闭引流(VSD)治疗2~3 d,Ⅱ期行大张自体刃厚头皮与异体脱细胞真皮基质复合移植修复腘窝周围创面。术后8~10 d更换敷料查看皮片成活情况,皮片成活1周后在康复治疗师指导下进行12个月有序的膝关节功能训练。术后植皮区及边缘瘢痕增生明显予以强脉冲光与超脉冲二氧化碳点阵激光联合的序贯治疗5~7个疗程。结果 15例患儿皮片成活良好;1例患儿因移植自体头皮部分移位形成创面,1例患儿肢体移植皮片下血浆肿形成,经开洞引流,这2例病例经3周换药后创面愈合。术后随访6~36个月,皮片弹性及外观接近中厚皮片效果,膝关节挛缩患儿可完全伸直至180°,膝关节功能明显改善,供皮区无瘢痕形成及脱发现象发生。结论复合皮移植结合系统康复治疗儿童烧伤后腘窝周围大范围瘢痕挛缩畸形效果较好,避免了因取自体皮片供区遗留瘢痕的问题。Objective To explore the clinical effect of composite skin transplantation combined with systemic rehabilitation in the treatment of extensive scar contracture deformity around the popliteal fossa in children after burns.Methods A retrospective observational research method was adopted.Seventeen children with extensive scar contracture deformities around the popliteal fossa after burns who met the inclusion criteria and were admitted to the First Affiliated Hospital of Air Force Military Medical University from March 2018 to April 2022 were selected.Among them,there were 10 males and 7 females,aged 2-11 years,with scar contracture deformities lasting from 10 months to 9 years,all located around the popliteal fossa,10 cases of right popliteal fossa,5 cases of left popliteal fossa,2 cases of bilateral popliteal fossa,scars around the popliteal fossa result in a knee joint extension angle of only 95°to 115°.The scar contracture during surgery was thoroughly released,joint mobility was restored,so as to form a secondary wound range of 10 cm×8 cm-20 cm×13 cm.In stageⅠ,after completely releasing the scar contracture,the wound was covered with negative pressure closure drainage(VSD)for 2-3 days.In stageⅡ,a large autologous blade thick scalp and allogeneic decellularized dermal matrix composite graft was performed to repair the wound around the popliteal fossa.After 8-10 days of surgery,the dressing was changed to check the survival of the skin graft.One week after the skin graft survived,a 12 month orderly knee joint function training was conducted under the guidance of a rehabilitation therapist.Postoperative sequential treatment with a combination of strong pulsed light and ultra pulsed carbon dioxide lattice laser for 5-7 courses of significant scar hyperplasia in the skin graft area and edges.Results 15 cases of pediatric patients had good skin graft survival;One patient developed a wound due to partial displacement of the transplanted autologous scalp,and one patient developed a plasma swelling under the li

关 键 词：烧伤 皮肤移植 儿童 瘢痕 关节 复合皮 

分 类 号：R726.5[医药卫生—儿科]