脱细胞异体真皮联合自体刃厚头皮在瘢痕修复中的应用效果  

Application effect of acellular allogeneic dermal matrix combined with autologous razor-thin scalp grafts in scar rehabilitation

作　　者：邝江波 王永飞[2] 许喜生[2] 李柏同[2] Kuang Jiangbo;Wang Yongfei;Xu Xisheng;Li Botong(Department of Emergency Medicine,the First People’s Hospital of Chenzhou,Chenzhou 423000,China;Department of Burns and Plastic Surgery,the First People’s Hospital of Chenzhou,Chenzhou 423000,China)

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

出　　处：《中华整形外科杂志》2024年第6期641-650,共10页Chinese Journal of Plastic Surgery

摘　　要：目的探讨脱细胞异体真皮联合自体刃厚头皮在瘢痕修复中的应用效果。方法回顾性分析2015年7月至2021年12月于郴州市第一人民医院烧伤整形外科行皮片移植修复瘢痕的患者临床资料,按手术方式分成观察组和对照组,观察组采用脱细胞异体真皮联合自体刃厚头皮移植修复瘢痕切除后继发创面,对照组采用中厚皮片移植修复瘢痕切除后继发创面。疗效评估:术后第1、7、14天由2组患者通过视觉模拟评分法(VAS)对供皮区疼痛程度进行评分,0分表示无疼痛,10分表示重度疼痛;采用网格法测量皮片成活面积,计算皮片成活比例;记录供、受区创面愈合时间;观察并发症发生情况,计算并发症发生率;术后3、6、9、12个月对供、受区瘢痕情况进行观察,并采用温哥华瘢痕量表(VSS)对受区瘢痕进行评分,总分0~13分,分值越高表示瘢痕情况越严重。采用SPSS 22.0软件对数据进行统计学分析,符合正态分布的计量资料以±s表示,组间比较采用t检验,非正态分布计量资料采用M(Q1,Q3)表示,组间比较采用Wilcoxon秩和检验;计数资料以例和(或)百分比表示,组间比较采用χ^(2)检验。P<0.05表示差异有统计学意义。结果观察组纳入50例,男28例,女22例,年龄(38.5±13.9)岁;上肢16例、下肢15例、躯干11例、颈部8例;瘢痕切除后形成的创面面积为(70.4±17.7)cm2。对照组纳入50例,男30例,女20例,年龄(34.8±14.6)岁;上肢15例、下肢11例、躯干13例、颈部11例;瘢痕切除后形成的创面面积为(66.2±16.5)cm2。2组患者性别构成、年龄、皮片移植部位、瘢痕切除后形成的创面面积比较,差异均无统计学意义(P均>0.05)。术后第1、7、14天,观察组VAS评分分别为6.35(5.11,7.67)、4.95(3.63,6.46)、0.73(0.18,1.39)分,对照组分别为8.25(7.14,9.19)、7.00(5.45,8.06)、0.80(0.20,1.55)分,术后第1、7天观察组VAS评分均低于对照组(Z=-4.53,-3.86,P均<0.001),术后第14天,2组VAS评�Objective To investigate the efficacy of acellular allogeneic dermal matrix(ADM)combined with autologous razor-thin scalp grafts in scar rehabilitation.Methods A retrospective study was conducted on patients who underwent skin grafts transplantation to repair scar in the Department of Burns and Plastic Surgery of the First People’s Hospital of Chenzhou from July 2015 to December 2021.All the patients were divided into the observation group and the control group according to surgical methods.The observation group was treated with ADM combined with autologous razor-thin scalp grafts to repair the wound after scar resection,and the control group was treated with split-thickness skin grafts(STSGs)to repair the wound.Efficacy evaluation:On the 1st,7th and 14th day after surgery,the patients in the two groups scored the pain degree of the donor sites through the visual analogue scale(VAS),with a score of 0 indicating no pain and a score of 10 indicating severe pain.The grid method was used to measure the surviving area of the skin and calculate the surviving proportion of the skin grafts.The wound healing time in donor and recipient sites were recorded.The postoperative complication was recorded,and the incidence of complications was calculated.Scars in donor and recipient sites were observed at the 3rd,6th,9th and 12th month after surgery,and the scars in recipient sites were scored by the Vancouver scar scale(VSS),with a total score of 0-13 points,and the higher the score,the more serious the scars were.SPSS 22.0 software was used for statistical analysis of the data.The normally distributed continuous data were represented as Mean±SD,and analyzed by t-test,and the non-normally distributed continuous data were represented as M(Q1,Q3),and the Wilcoxon rank-sum test was used for comparison between groups.Enumeration data were expressed as examples and(or)percentages,and chi-square test was used for comparison between groups.The differences were considered statistically significant for probability values P<0.05.Resul

关 键 词：皮肤移植 瘢痕 脱细胞异体真皮 头皮 刃厚皮片 

分 类 号：R622[医药卫生—整形外科]