邮票异体皮植皮在特重度烧伤Meek皮片移植失败后的应用  

Application of stamp-shaped skin allograft in extremely severe burns following failure of Meek skin grafting

作　　者：田晨阳 陶克 计鹏 王耘川 胡大海 高晓文 郑朝 Tian Chenyang;Tao Ke;Ji Peng;Wang Yunchuan;Hu Dahai;Gao Xiaowen;Zheng Zhao(Department of Burns and Skin Surgery,The First Affiliated Hospital of Air Force Military Medical University,Xi’an 710000,Shaanxi Province,China;Department of Wound Repair,Wound Repair Center and Regenerative Medicine Center,The First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,Zhejiang Province,China)

机构地区：[1]空军军医大学第一附属医院烧伤与皮肤外科,陕西省西安市710000 [2]温州医科大学附属第一医院创面修复中心与再生医学中心创面修复科,浙江省温州市325000

出　　处：《中国组织工程研究》2025年第12期2507-2512,共6页Chinese Journal of Tissue Engineering Research

基　　金：陕西省一般项目课题(2022SF-044),项目负责人:田晨阳。

摘　　要：背景:部分特重度烧伤患者采用Meek皮片移植的术后效果并不能令人满意,出现了延迟愈合或皮片移植失败的问题。对于皮源不足的Meek皮片移植失败患者的治疗研究较少,此次研究探索了一种治疗的新方法。目的:观察邮票异体皮植皮技术在特重度烧伤Meek皮片移植失败后的疗效。方法:纳入空军军医大学第一附属医院烧伤科2013年8月至2023年8月收治Meek皮片移植术后愈合不良的23例特重度烧伤患者,根据治疗方式不同分为2组,其中异体皮治疗组10例,换药组13例。对比两组患者二次Meek植皮术前血红蛋白、血小板计数、白蛋白计数、白细胞计数、中性粒细胞,降钙素原及微生物培养阳性率;二次Meek植皮术前、术后皮片成活率;手术次数及脓毒血症发生率;以及术后3,6个月创面瘢痕情况。结果与结论:①异体皮治疗组的二次Meek植皮术前血红蛋白、血小板计数、白蛋白计数均明显高于换药组(Z=-3.172,P=0.002;Z=-3.010,P=0.003;Z=-2.761,P=0.006);②两组二次Meek植皮术前白细胞计数、中性粒细胞相比差异无显著性意义(Z=1.148,P=0.251;Z=0.373,P=0.709);但异体皮治疗组二次术前降钙素原计数明显低于换药组(Z=2.955,P=0.002);③换药组烧伤患者二次术前微生物培养阳性率高于异体皮治疗组(χ^(2)=6.303,P=0.029);④异体皮治疗组的二次Meek植皮术前植皮成活率(74.8±13.3)%明显高于换药组(58.4±14.2)%(t=2.85,P=0.01),术后植皮成活率(84.0±11.5)%明显高于换药组(67.6±20.7)%(t=2.24,P=0.03);⑤异体皮治疗组后期手术次数少于换药组(Z=2.27,P=0.02);⑥换药组烧伤患者脓毒血症发生率明显高于异体皮治疗组(χ^(2)=5.490,P=0.03);⑦两组手术后3,6个月瘢痕温哥华瘢痕量表评分相比差异无显著性意义(t=0.960,1.138,P>0.05);⑧提示邮票状异体皮在治疗Meek微型移植术后皮片愈合不良创面时具有较好的疗效,患者后期皮片利用率明显增高,减少了创�BACKGROUND:Postoperative results with Meek skin grafting in some patients with extremely severe burns have not been satisfactory,with problems of delayed healing or skin graft failure.There have been fewer studies on the treatment of patients with failed Meek skin grafting due to insufficient skin source.This study aimed to explore a treatment method for such patients.OBJECTIVE:To observe the curative effect of stamp-shaped skin allograft in the treatment of severe burns after Meek skin graft failure.METHODS:Twenty-three patients with extremely severe burns who were admitted at Department of Burns and Skin Surgery,the First Affiliated Hospital of the Air Force Medical University from August 2013 to August 2023 with poor healing after Meek skin grafting were enrolled and divided into allogeneic skin treatment group and dressing change group according to different treatment methods.There were 10 cases in the allograft group and 13 cases in the dressing change group.Preoperative hemoglobin,platelet count,albumin count,white blood cell count,neutrophil count,procalcitonin count,and positive rate of microbial culture before secondary Meek skin grafting were compared between two groups.Survival rate of skin grafts before and after the second operation were compared.The number of operations,incidence of sepsis,and wound scars at 3 months and 6 months after operation were retrospectively analyzed.RESULTS AND CONCLUSION:The preoperative hemoglobin,platelet count and albumin count in the allogeneic skin treatment group were significantly higher than those in the dressing change group(Z=-3.172,P=0.002;Z=-3.010,P=0.003;Z=-2.761,P=0.006).There was no significant difference in the preoperative white blood cell count and neutrophil count between the two groups before secondary Meek skin grafting(Z=1.148,P=0.251;Z=0.373,P=0.709),but the serum procalcitonin count in the allogeneic skin treatment group prior to the second operation was significantly lower than that in the dressing change group(Z=2.955,P=0.002).Burn patients in the

关 键 词：特重度烧伤 大面积烧伤 邮票异体皮植皮术 Meek皮片移植 延迟愈合 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R62