| 徐佳丽,张小林,龙 航,朱 珠,韩 鹏,陈飞艳,王玉波,王开玖,郭 曼.邮票植皮联合异种ADM治疗大面积深度烧伤疗效观察[J].中国烧伤创疡杂志,2018,(2):121~124. |
| DOI： |
| 中文关键词: 邮票植皮 异种脱细胞真皮基质 烧伤 疗效 |
| 英文关键词:Stamp skin grafting Xeno-ADM (acellular dermal matrix) Burns Efficacy |
| 基金项目:基金项目: 毕节市科技联合基金(毕科合字[2014]50号) |
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| 中文摘要: |
| 【摘要】 目的 观察邮票植皮联合异种脱细胞真皮基质(acellular dermal matrix, ADM) 治疗大面积深度烧伤创面的临床疗效?方法 对2014 年4 月至2017 年4 月毕节市第一人民医院烧伤整形手外科收治的14 例大面积深Ⅱ度及Ⅲ度烧伤患者采用邮票植皮联合异种ADM 治疗, 分别于术后第3?6?12?15 天观察创面ADM 的湿度?弹性及与创面的贴附情况, 以及皮片成活情况?创面愈合时间及愈合效果?结果 所有患者均顺利完成邮票植皮联合异种ADM 治疗, 其中深Ⅱ度烧伤创面及部分Ⅲ度烧伤创面于1 次植皮后被完全覆盖, 皮片完全成活; 部分Ⅲ度烧伤创面于2 ~3 次植皮后被完全覆盖, 皮片成活良好?术后第3?6 天, 深Ⅱ度及Ⅲ度烧伤创面的ADM 均较湿润?弹性良好?紧贴创面; 术后第12 天, 深Ⅱ度烧伤创面的大部分ADM 干燥?弹性较差?少许与创面分离, Ⅲ度烧伤创面的大部分ADM 湿润?弹性尚可?贴附良好; 术后第15 天, 深Ⅱ度烧伤创面的ADM 均较干燥?弹性较差?大部分与创面分离, Ⅲ度烧伤创面的大部分ADM 湿润?弹性尚可?贴附良好?所有患者创面均完全愈合, 其中深Ⅱ度烧伤创面平均愈合时间为15 d, Ⅲ度烧伤创面愈合时间为15 ~35 d?患者出院后随访4 ~12 个月, 部分深Ⅱ度烧伤创面愈后留有轻度色素沉着和(或) 扁平瘢痕, 部分Ⅲ度烧伤创面愈后留有增生性瘢痕?结论 邮票植皮联合异种ADM 治疗大面积深度烧伤创面, 可通过观察ADM 的湿度?弹性及与创面的贴附程度初步判断创面修复情况; 邮票植皮联合异种ADM 治疗深Ⅱ度烧伤创面, 可有效促进创面修复, 缩短创面愈合时间,疗效显著, 是修复深Ⅱ度烧伤创面较为理想的方法, 值得临床推广应用; 而邮票植皮联合异种ADM 治疗Ⅲ度烧伤创面, 虽然最终治疗效果欠佳, 但能有效保护创面不受外界细菌侵袭, 促进肉芽组织生长, 为Ⅲ度烧伤创面的修复打下良好的基础? |
| 英文摘要: |
| 【Abstract】 Objective To observe the clinical efficacy of stamp skin grafting combined with xeno-ADM in treating extensive deep burns. Methods Fourteen patients with extensive deep second degree and third degree burns admitted to Burns, Plastics & Hand Surgery Dept. of Bijie First People’s Hospital between April 2014 and April 2017 were treated with stamp skin grafting combined with xeno-ADM. The moisture and elasticity of ADM on wound surface, ADM attachment condition to wound surface, skin graft survival, wound healing time and effect were observed respectively on day 3, 6, 12 and 15 post operation. Results Stamp skin grafting combined with xeno-ADM was performed successfully on all patients. Deep second degree burn wounds and some third degree burn wounds were entirely covered with new skin after one-time skin grafting and all skin flaps survived; some third degree burn wounds were entirely covered with new skin after 2 -3 times of skin grafting and the skin flaps grew well. On day 3 and 6 after surgery, the ADM on the deep second and third degree burn wounds were much moist and elastic and adhered to wound surface tightly; on day 12 after surgery, most ADM on deep second degree burn wounds was dry, lack of elasticity and some of them were separated from the wound surface while most ADM on third degree burn wounds were moist, elastic and well attached to wound surface; On day 15, all ADM on deep second degree burn wounds were dry, lack of elasticity and most of them were separated from the wound surface while most ADM on third degree burn wounds were moist, elastic and attached to wound surface tightly; The wounds of all patients were healed completely. The average healing time for the deep second degree burn wound was 15 d and for the third degree burn wounds was 15 -35 d. During the follow up 4 -12 months after discharge, mild pigmentation and (or) flat scar were observed on some deep second degree burn wounds and hypertrophic scars were found on some third degree burn wounds.Conclusion In the treatment of extensive deep burns with stamp skin graft combined with xeno-ADM, the preliminary wound repair condition can be evaluated by observing the moisture and elasticity of ADM and its adhesion to wound surface.The therapy of stamp skin grafting combined with xeno-ADM is an ideal approach to repairing deep second burns with its significant clinical effects including effectively promoting wound repair and shortening wound healing time. Though with less satisfying final clinical efficacy for the treatment of third degree burn wounds, stamp skin grafting combined with xeno-ADM can effectively protect the wound from the invasion of bacteria and promote the growth of granulation tissues, laying a sound foundation for the repair of such wounds. |
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