保湿促脱痂结合自体大张中厚皮片移植修复手部深度烧伤创面的远期效果  

Long-term effects of moisturizing and desecrasing combined with autologous large and medium thickness skin graft for re-pairing deep hand burn wounds

作　　者：徐培 张红玲 童欢 龙忠恒 张祥明 XU Pei;ZHANG Hongling;TONG Huan;LONG Zhongheng;ZHANG Xiangming(Department of Shin Wound Repair Center,Tongren Hospital of Wuhan University&Wuhan Third Hospital,Wuhan 430070,China)

机构地区：[1]武汉大学同仁医院暨武汉市第三医院皮肤创面修复中心,湖北武汉430070 [2]武汉大学同仁医院暨武汉市第三医院中医科,湖北武汉430070

出　　处：《中国美容整形外科杂志》2024年第7期402-404,410,共4页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的 探讨应用保湿促脱痂结合自体大张中厚皮片移植修复手部深度烧伤创面的远期效果。方法 回顾性分析自2015年1月至2021年12月,武汉大学同仁医院暨武汉市第三医院皮肤创面修复中心收治18例(30只手)烧伤合并手部深度烧伤患者,烧伤总面积(total body surface area,TBSA)≤30%,胸背部及头部皮肤正常。手部创面深度Ⅱ°~Ⅲ°,不伴有肌腱和/或骨质外露。手部创面采用0.2%~0.3%稀释碘伏冲洗消毒,外用磺胺嘧啶银(SD-Ag)霜及凡士林纱布保湿包扎换药,隔日1次,换药过程中及时清除创面明显坏死组织。待伤后3周左右手部创面坏死痂皮脱落,新生肉芽组织形成,采用胸背部大张中厚皮片移植修复创面,范围超过掌指关节,包括部分指背深度创面,头部刃厚邮票皮片修复胸背部供皮区。手部创面愈合后1周开始指导患者行康复训练及预防瘢痕增生。观察记录手部移植皮片成活情况。采用Carroll上肢功能评定标准评估手部功能。结果 18例患者烧伤创面均愈合。30只手部深度创面移植自体大张中厚皮片成活良好,未出现感染。头部供皮区愈合良好,胸背部瘢痕增生程度较轻。所有患者随访1~5年,手部瘢痕增生不明显,掌指关节无背伸畸形,手部外形及功能恢复良好。Carroll手功能评分90~99分,功能达Ⅴ、Ⅵ级。结论 保湿促脱痂结合自体大张中厚皮片移植是修复手部深度烧伤创面的良好方法,愈合创面瘢痕增生挛缩程度较轻,远期效果显著,手部外形及功能恢复较佳。Objective To investigate the long-term effects of moisturizing and desecscating combined with autologous large and thick skin graft for repairing deep hand burn wounds.Methods A retrospective systematic case study was conducted to analyze 18 pa-tients(30 hands)with burns complicated with deep hand burns admitted to Department of Skin Wound Repair Center,Tongren Hospital of Wuhan University&Wuhan Third Hospital from January 2015 to December 2021.with total burn area≤30%TBSA and normal skin on chest,back and head.The wound depth of hand wasⅡ°~Ⅲ°.without tendon and/or bone exposure.Hand wounds were washed and dis-infected with 0.2%~0.3%iodophor,and moisturized and dressed with silver sulfadiazine(SD-Ag)cream and vaseline gauze once every other day.The obvious necrotic tissue on the wounds was removed in time during dressing change.About 3 weeks after the injury,necrotic scab and new granulation tissue were shed on the wound surface of the hand.Large and thick skin grafts on the back of the chest were used to repair the wound surface,covering more than the metacarpophalangeal joint,including some deep wounds on the back of the finger.Thick stamp skin grafts on the head were used to repair the donor skin area of the back of the chest.Early rehabilitation exercise and pre-vention of scar hyperplasia after hand wound healing.The survival of hand skin graft was observed and recorded.Hand function was as-sessed by Carroll upper limb function assessment criteria.Results All the burns healed in 18 patients.Thirty deep wound autografts sur-vived well without infection.The skin donor area of the head healed well,and the scar hyperplasia of the chest and back was light.The pa-tients were followed up for 1 to 5 years.There was no obvious scar hyperplasia of the hand,no dorsiflexion deformity of the metacarpopha-langeal joint,and the shape and function of the hand recovered well.Carroll's hand function scores ranged from 90 to 99,reaching V and VI.Conclusion Moisturizing and desecscating combined with autologous large an

关 键 词：深度烧伤 移植 手 中厚皮片 大张 脱痂 

分 类 号：R644[医药卫生—外科学]