烧伤后期瘢痕整形手术应用异体脱细胞真皮基质与自体薄皮片复合移植的临床研究
|
摘要
目的:总结大面积烧伤后期瘢痕畸形整形应用异体脱细胞真皮基质(ADM)+自体薄皮片复合移植的术后效果,为提高异体ADM移植的成功率提供临床经验。方法:2010年1月-2015年12月在大面积烧伤后期瘢痕整形手术中应用异体ADM与自体薄皮片复合移植201例,手术行瘢痕局部切除、挛缩松解,异体ADM覆盖于创面,四周缝线固定,其上以自体头部或其他部位薄皮片来覆盖,抗菌敷料外敷加压包扎或局部打包固定。术后观察创面情况和随访半年以上的治疗效果。结果:191例(95.02%)异体ADM与自体薄皮片复合移植区皮片成活较好,无疼痛和感染征象,术后6个月随访,复合皮移植区局部外观较好,质地柔软,弹性好,皮片无挛缩,无明显瘢痕形成,关节活动功能明显改善,但部分有色素沉着。10例(4.98%)患者,瘢痕位于口周、下颌或腋窝,术后1周左右创面局部有疼痛,术区敷料有异味,全身发热,自体薄皮片全部液化坏死,异体ADM部分失活、溶解脱落。结论:异体ADM与自体薄皮片复合移植是修复大面积烧伤后期瘢痕畸形的较好方法。
Objective To summarize the postoperative results of acellular allograft dermal matrix combined with autologous skin thin graft in the treatment of extensive post-burn scar deformity late application,provide clinical experience for improving acellular allograft dermal matrix graft success rate.Methods From January 2010 to December 2015,201 cases of large area post-burn scar plastic surgery were performed in patients with autologous thin skin graft and allograft acellular dermal matrix.Local excision of the surgical scar,contracture release,removal of allogenic acellular dermis matrix to cover the wound,around suture fixation,to autologous head or other parts of the thin skin graft to cover,antibacterial dressing external compression bandage or local packaged fixed.The treatment effect of the wound was observed after operation and the patients were followed up for more than half a year.Results In 191 cases(95.02%) allogenic acellular dermal matrix and autologous thin skin graft composite grafting regions skin graft survival better and no signs of pain and infection,after 6 months of follow-up,composite skin graft area local appearance better,soft texture,good elasticity,skin graft without contracture,no obvious scar,joint function improved significantly,but part of the pigmentation.10 cases(4.98%) patients,scar is located in around the mouth,jaw or axillary,about 1 week postoperation wound pain,surgical dressings have peculiar smell,body heat,razor thin autoskin all liquefaction necrosis,allograft dermal matrix partial inactivation,dissolved off.Conclusion Allograft acellular dermal matrix combined with autologous thin skin graft is a good method for the repair of large area post-burn scar deformity.
Objective To summarize the postoperative results of acellular allograft dermal matrix combined with autologous skin thin graft in the treatment of extensive post-burn scar deformity late application,provide clinical experience for improving acellular allograft dermal matrix graft success rate.Methods From January 2010 to December 2015,201 cases of large area post-burn scar plastic surgery were performed in patients with autologous thin skin graft and allograft acellular dermal matrix.Local excision of the surgical scar,contracture release,removal of allogenic acellular dermis matrix to cover the wound,around suture fixation,to autologous head or other parts of the thin skin graft to cover,antibacterial dressing external compression bandage or local packaged fixed.The treatment effect of the wound was observed after operation and the patients were followed up for more than half a year.Results In 191 cases(95.02%) allogenic acellular dermal matrix and autologous thin skin graft composite grafting regions skin graft survival better and no signs of pain and infection,after 6 months of follow-up,composite skin graft area local appearance better,soft texture,good elasticity,skin graft without contracture,no obvious scar,joint function improved significantly,but part of the pigmentation.10 cases(4.98%) patients,scar is located in around the mouth,jaw or axillary,about 1 week postoperation wound pain,surgical dressings have peculiar smell,body heat,razor thin autoskin all liquefaction necrosis,allograft dermal matrix partial inactivation,dissolved off.Conclusion Allograft acellular dermal matrix combined with autologous thin skin graft is a good method for the repair of large area post-burn scar deformity.
引文
[1]李辉,陈军,苏开新.异体脱细胞真皮基质与自体皮片复合移植增生性瘢痕临床应用探讨[J].中国烧伤疮疡杂志,2010,22(3):216-219.
[2]周杰,罗艺,徐刚,等.脱细胞真皮基质加自体瘢痕表皮在瘢痕挛缩畸形整复中的应用[J].中国美容医学,2012,21(9):1498.
[3]潘云川,徐家钦,袁素,等.异体脱细胞真皮基质加自体刃厚皮复合移植远期随访评价[J].中华烧伤杂志,2010,26(6):439-443.
[4]曹建平.复合皮移植修复颈部瘢痕挛缩畸形10例的护理[J].中国医药导报,2012,9(18):140-141.
[5]陈璧,贾赤宇,徐明达,等.自体皮源奇缺条件下瘢痕挛缩畸形的晚期临床修复[J].中华烧伤杂志,2003,19(6):361-364.
[6]任烨,邓辰亮,杨松林.脱细胞真皮基质在整形外科领域的研究及应用进展[J].中国美容整形外科杂志,2014,25(8):474-478.
[7]孟祥海,主晓林,李学拥,等.复合皮移植修复烧伤功能部位创面疗效评价[J].中国修复重建外科杂志,2012,26(2):219-222.
[8]徐祥,吕大伦.脱细胞真皮基质临床研究及应用进展[J].临床医学工程,2014,21(3):396-398.
[9]Jiong C,Jiake C,Chunmao H,et al.Clinical application and long-term follow-up study6 of porcine acellular dermal matrix combined with autoskin grafting[J].J Burn Care Res,2010,31(2):280-285.
[10]蔡景龙.现代瘢痕学[M].2版.北京:人民卫生出版社,2008:400-425.
[11]陈斌,段体武.脱细胞真皮基质的研究进展[J].中国美容医学,2001,10(4):358-359.
[12]赵高峰,何乐人.脱细胞真皮在整形外科领域的应用进展[J].中国美容医学,2010,19(7):1093-1096.
[13]陆树良,青春,刘英开,等.癫痕形成机制的研究:真皮“模板缺攒”学说[J].中华烧伤杂志,2007,23(1):6-12.
[14]李守聚.异体脱细胞基质与自体皮片复合移植的临床应用[J].中国美容医学,2012,21(9):1484-1486.
[15]潘云川,徐家钦,袁素,等.异体脱细胞真皮基质加自体刃厚皮复合移植远期随访评价[J].中华烧伤杂志,2010,26(6):439-443.
[16]唐修俊,李丰,魏在荣,等.异体脱细胞真皮基质联合自体刃厚皮移植修复供瓣区20例[J].中华烧伤杂志,2015,31(3):226-228.
[17]蔡景龙.瘢痕整形美容外科学[M].杭州:浙江科学技术出版社,2015:242.
[2]周杰,罗艺,徐刚,等.脱细胞真皮基质加自体瘢痕表皮在瘢痕挛缩畸形整复中的应用[J].中国美容医学,2012,21(9):1498.
[3]潘云川,徐家钦,袁素,等.异体脱细胞真皮基质加自体刃厚皮复合移植远期随访评价[J].中华烧伤杂志,2010,26(6):439-443.
[4]曹建平.复合皮移植修复颈部瘢痕挛缩畸形10例的护理[J].中国医药导报,2012,9(18):140-141.
[5]陈璧,贾赤宇,徐明达,等.自体皮源奇缺条件下瘢痕挛缩畸形的晚期临床修复[J].中华烧伤杂志,2003,19(6):361-364.
[6]任烨,邓辰亮,杨松林.脱细胞真皮基质在整形外科领域的研究及应用进展[J].中国美容整形外科杂志,2014,25(8):474-478.
[7]孟祥海,主晓林,李学拥,等.复合皮移植修复烧伤功能部位创面疗效评价[J].中国修复重建外科杂志,2012,26(2):219-222.
[8]徐祥,吕大伦.脱细胞真皮基质临床研究及应用进展[J].临床医学工程,2014,21(3):396-398.
[9]Jiong C,Jiake C,Chunmao H,et al.Clinical application and long-term follow-up study6 of porcine acellular dermal matrix combined with autoskin grafting[J].J Burn Care Res,2010,31(2):280-285.
[10]蔡景龙.现代瘢痕学[M].2版.北京:人民卫生出版社,2008:400-425.
[11]陈斌,段体武.脱细胞真皮基质的研究进展[J].中国美容医学,2001,10(4):358-359.
[12]赵高峰,何乐人.脱细胞真皮在整形外科领域的应用进展[J].中国美容医学,2010,19(7):1093-1096.
[13]陆树良,青春,刘英开,等.癫痕形成机制的研究:真皮“模板缺攒”学说[J].中华烧伤杂志,2007,23(1):6-12.
[14]李守聚.异体脱细胞基质与自体皮片复合移植的临床应用[J].中国美容医学,2012,21(9):1484-1486.
[15]潘云川,徐家钦,袁素,等.异体脱细胞真皮基质加自体刃厚皮复合移植远期随访评价[J].中华烧伤杂志,2010,26(6):439-443.
[16]唐修俊,李丰,魏在荣,等.异体脱细胞真皮基质联合自体刃厚皮移植修复供瓣区20例[J].中华烧伤杂志,2015,31(3):226-228.
[17]蔡景龙.瘢痕整形美容外科学[M].杭州:浙江科学技术出版社,2015:242.