Meek微型皮片植皮技术在成批烧伤患者救治中的临床应用
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摘要
目的:探讨Meek微型皮片植皮技术在成批烧伤救治中的临床应用。方法:2012年2月-2015年2月,选择笔者单位收治的成批大面积深度烧伤患者64例。其中32例患者创面进行Meek微型皮片移植修复,32例患者创面进行微粒皮移植。比较两组使用自体皮肤面积、手术时间、创面愈合时间、住院时间、术后7d移植皮片成活率及治疗2周创面完全愈合率。结果:Meek植皮组患者使用自体皮肤面积明显小于使用微粒植皮组,术后2周创面愈合率明显高于微粒植皮组,创面愈合时间和住院天数明显短于微粒植皮组,差异有统计学意义(P<0.05);且Meek植皮组患者创面愈合后半年瘢痕增生明显轻于微粒植皮组,差异有统计学意义(P<0.05)。两组移植皮片成活率、手术时间比较差异无统计学意义(P>0.05)。结论:Meek微型皮片移植是成批救治烧伤中较为理想的皮片移植技术,能明显节省自体皮源,且缩短了创面愈合周期及住院天数,提高了创面愈合率,值得在临床上推广应用。
Objective To explore the clinical application of Meek skin grafting in the treatment of batch burns. Methods From February 2012 to February 2015, 64 patients with extensive deep burn were selected from our hospital. Among them, 32 cases were repaired with Meek skin graft and 32 cases were repaired with micro-skin graft. The area of autologous skin, operation time, wound healing time, hospitalization time, survival rate of skin graft 7 days after operation and complete healing rate of wound 2 weeks after treatment were compared between the two groups. Results The area of autologous skin in Meek skin grafting group was significantly smaller than that in micro-skin grafting group, the wound healing rate in 2 weeks after operation was significantly higher than that in micro-skin grafting group, the wound healing time and hospitalization days in Meek skin grafting group were significantly shorter than those in micro-skin grafting group, the differences were statistically significant(P<0.05). The scar hyperplasia in Meek skin grafting group was significantly lighter than that in micro-skin grafting group half a year after wound healing(P<0.05). There was no significant difference in survival rate and operation time between the two groups(P>0.05). Conclusion Meek skin graft is an ideal skin graft technique for mass burn treatment. It can save autologous skin sources, shorten the healing cycle and hospitalization days, and improve the healing rate of wounds. It is worth popularizing and applying in clinic.
Objective To explore the clinical application of Meek skin grafting in the treatment of batch burns. Methods From February 2012 to February 2015, 64 patients with extensive deep burn were selected from our hospital. Among them, 32 cases were repaired with Meek skin graft and 32 cases were repaired with micro-skin graft. The area of autologous skin, operation time, wound healing time, hospitalization time, survival rate of skin graft 7 days after operation and complete healing rate of wound 2 weeks after treatment were compared between the two groups. Results The area of autologous skin in Meek skin grafting group was significantly smaller than that in micro-skin grafting group, the wound healing rate in 2 weeks after operation was significantly higher than that in micro-skin grafting group, the wound healing time and hospitalization days in Meek skin grafting group were significantly shorter than those in micro-skin grafting group, the differences were statistically significant(P<0.05). The scar hyperplasia in Meek skin grafting group was significantly lighter than that in micro-skin grafting group half a year after wound healing(P<0.05). There was no significant difference in survival rate and operation time between the two groups(P>0.05). Conclusion Meek skin graft is an ideal skin graft technique for mass burn treatment. It can save autologous skin sources, shorten the healing cycle and hospitalization days, and improve the healing rate of wounds. It is worth popularizing and applying in clinic.
引文
[1]付合军,卢勇,郭瑞,等.Meek微型皮片移植术联合碳纤维敷料修复深度烧伤创面的疗效观察[J].中国临床研究,2016,29(6):785-787.DOI:10.13429/j.cnki.cjcr.2016.06.019.
[2]叶胜捷,张文振,庞淑光,等.应用Meek微型皮片移植术修复老年成批大面积烧伤创面的疗效观察[J/CD].中华损伤与修复杂志(电子版),2015,10(3):44-47.DOI:10.3877/cma.j.issn.1673-9450.2015.03.012.
[3]蒋建纲,樊新海,张朔,等.非头部反复取皮移植手术在大面积深度烧伤患者中的应用价值[J].中国现代手术学杂志,2015,19(1):50-52.DOI:10.16260/j.cnki.1009-2188.2015.01.015.
[4]Kim KS,Kim ES,Hwang JH,et al.Medial sural perforator plus island flap:a modification of the medial sural perforator plus island flap for the reconstruction of postburn knee flexion contractures using burned calf skin[J].J Plast Reconstr Aesthet Surg,2012,65(6):804-809.DOI:10.1016/j.bjps.2011.12.018.
[5]Kazemi-Darabadi S,Sarrafzadeh-Rezaei F,Farshid AA,et al.Allogenous skin fibroblast transplantation enhancea excisional wound healing following alloxan diabetes in sheep,a randomized controlled trial[J].Int JSurg,2014,12(8):751-756.DOI:10.1016/j.ijsu.2014.06.007.
[6]谭谦,邱海波,孙炳伟,等.抢救"八二"昆山爆炸伤员的模式及启示[J].中华烧伤杂志,2016,32(1):26-30.DOI:10.3760/cma.j.issn.1009-2587.2016.01.008.
[7]陆树良.烧伤创面愈合的理论探索和临床实践[J].中华烧伤杂志,2008,24(5):359-361.DOI:10.3760/cma.j.issn.1009-2587.2008.05.014.
[8]杨宗成.烧伤治疗学[M].3版.北京:人民卫生出版社,2006:220-223.
[9]叶胜捷,张文振,庞淑光,等.Ⅲ度烧伤面积≥80%体表总面积患者应用Meek植皮术的疗效观察[J/CD].中华损伤与修复杂志(电子版),2013,8(6):35-38.DOI:10.3877/cma.j.issn.1673-9450.2013.06.010.
[10]刘亦峰,刘森,周荣芳,等.大面积深度烧伤伴双手深度烧伤的治疗策略[J/CD].中华损伤与修复杂志(电子版),2015,10(1):27-29.DOI:10.3877/cma.j.issn.1673-9450.2015.01.008.
[11]王春华,余又新,胡德林,等.不同植皮方式在修复大面积烧伤创面中疗效的对比研究[J].安徽医科大学学报,2015,50(8):1136-1138.
[12]Kim KS,Kim ES,Hwang JH,et al.Medial sural perforator plus island flap:a modification of the medial sural perforator plus island flap for the reconstruction of postburn knee flexion contractures using burned calf skin[J].J Plast Reconstr Aesthet Surg,2012,65(6):804-809.DOI:10.1016/j.bjps.2011.12.018.
[13]胡卫东,黄爱平,谢茜宇,等.Meek微型皮片移植修复大面积深度烧伤[J].中国组织工程研究与临床康复,2011,15(18):3405-3407.DOI:10.3969/j.issn.1673-8225.2011.18.043.
[14]Walls RM,Zinner MJ.The Boston Marathon response:why did it work so well?[J].JAMA,2013,309(23):2441-2442.DOI:10.1001/jama.2013.5965.
[15]Kellermann AL,Peleg K.Lessons from Boston[J].N Engl JMed,2013,368(21):1956-1957.DOI:10.1056/NEJMp130-5304.
[16]Giri P,Ebert S,Braumann UD,et al.Skin regeneration in deep second-degree scald injuries rather by infusion pumping or topical application of recombinant human erythropoirtin gel[J].Drug Des Devel Ther,2015,9:2565-2579.DOI:10.2147/DDDT.S79425.
[2]叶胜捷,张文振,庞淑光,等.应用Meek微型皮片移植术修复老年成批大面积烧伤创面的疗效观察[J/CD].中华损伤与修复杂志(电子版),2015,10(3):44-47.DOI:10.3877/cma.j.issn.1673-9450.2015.03.012.
[3]蒋建纲,樊新海,张朔,等.非头部反复取皮移植手术在大面积深度烧伤患者中的应用价值[J].中国现代手术学杂志,2015,19(1):50-52.DOI:10.16260/j.cnki.1009-2188.2015.01.015.
[4]Kim KS,Kim ES,Hwang JH,et al.Medial sural perforator plus island flap:a modification of the medial sural perforator plus island flap for the reconstruction of postburn knee flexion contractures using burned calf skin[J].J Plast Reconstr Aesthet Surg,2012,65(6):804-809.DOI:10.1016/j.bjps.2011.12.018.
[5]Kazemi-Darabadi S,Sarrafzadeh-Rezaei F,Farshid AA,et al.Allogenous skin fibroblast transplantation enhancea excisional wound healing following alloxan diabetes in sheep,a randomized controlled trial[J].Int JSurg,2014,12(8):751-756.DOI:10.1016/j.ijsu.2014.06.007.
[6]谭谦,邱海波,孙炳伟,等.抢救"八二"昆山爆炸伤员的模式及启示[J].中华烧伤杂志,2016,32(1):26-30.DOI:10.3760/cma.j.issn.1009-2587.2016.01.008.
[7]陆树良.烧伤创面愈合的理论探索和临床实践[J].中华烧伤杂志,2008,24(5):359-361.DOI:10.3760/cma.j.issn.1009-2587.2008.05.014.
[8]杨宗成.烧伤治疗学[M].3版.北京:人民卫生出版社,2006:220-223.
[9]叶胜捷,张文振,庞淑光,等.Ⅲ度烧伤面积≥80%体表总面积患者应用Meek植皮术的疗效观察[J/CD].中华损伤与修复杂志(电子版),2013,8(6):35-38.DOI:10.3877/cma.j.issn.1673-9450.2013.06.010.
[10]刘亦峰,刘森,周荣芳,等.大面积深度烧伤伴双手深度烧伤的治疗策略[J/CD].中华损伤与修复杂志(电子版),2015,10(1):27-29.DOI:10.3877/cma.j.issn.1673-9450.2015.01.008.
[11]王春华,余又新,胡德林,等.不同植皮方式在修复大面积烧伤创面中疗效的对比研究[J].安徽医科大学学报,2015,50(8):1136-1138.
[12]Kim KS,Kim ES,Hwang JH,et al.Medial sural perforator plus island flap:a modification of the medial sural perforator plus island flap for the reconstruction of postburn knee flexion contractures using burned calf skin[J].J Plast Reconstr Aesthet Surg,2012,65(6):804-809.DOI:10.1016/j.bjps.2011.12.018.
[13]胡卫东,黄爱平,谢茜宇,等.Meek微型皮片移植修复大面积深度烧伤[J].中国组织工程研究与临床康复,2011,15(18):3405-3407.DOI:10.3969/j.issn.1673-8225.2011.18.043.
[14]Walls RM,Zinner MJ.The Boston Marathon response:why did it work so well?[J].JAMA,2013,309(23):2441-2442.DOI:10.1001/jama.2013.5965.
[15]Kellermann AL,Peleg K.Lessons from Boston[J].N Engl JMed,2013,368(21):1956-1957.DOI:10.1056/NEJMp130-5304.
[16]Giri P,Ebert S,Braumann UD,et al.Skin regeneration in deep second-degree scald injuries rather by infusion pumping or topical application of recombinant human erythropoirtin gel[J].Drug Des Devel Ther,2015,9:2565-2579.DOI:10.2147/DDDT.S79425.