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目的研究人工真皮支架在大面积撕脱伤救治中的应用。方法回顾性分析第二军医大学长海医院烧创伤外科2011年1月至2014年12月收治的大面积撕脱伤患者20例,年龄6~68岁,撕脱面积占总体表面积(total body surface area,TBSA)10%~40%。按照治疗方法不同将患者分为两组,每组各10例,对照组患者一期行清创+负压引流术,二期行取植皮术;治疗组患者一期行清创+真皮支架+负压引流术,5~7d后更换负压装置,观察基底血管化程度,伤后12~14d行取植皮术。分别统计两组患者从清创到植皮的间隔时间,供皮区愈合时间和愈合质量以及植皮区皮片成活率、愈合时间及愈合质量。结果与对照组相比,治疗组患者从清创到植皮的间隔时间延长[(13.30±2.06)d vs(7.90±1.10)d,P<0.01];供皮区愈合时间缩短[(8.10±0.99)d vs(13.10±1.10)d,P<0.01],供皮区愈合质量提升(4.40±1.58vs 7.80±1.14,P<0.01);植皮区皮片成活率[(87.30±5.27)%vs(85.10±5.53)%]、愈合时间[(17.80±1.14)d vs(18.70±2.06)d]、愈合质量(8.40±1.07vs 9.00±1.05)差异均无统计学意义(P>0.05)。结论在大面积撕脱伤的治疗过程中早期应用真皮支架联合负压引流技术,可避免在伤后1周左右大范围取皮,手术损伤少,对全身干扰小,可保证患者平稳度过病程早期阶段;同时通过支架自身的血管化可促进创面恢复,减少植皮所需皮片厚度,从而缩短供皮区愈合时间、提高供皮区愈合质量。
Objective To study the application of artificial dermal stent in the treatment of extensive avulsion injury. Methods A retrospective analysis of 20 patients with large-area avulsion in the Department of Burns and Traumatology, Changhai Hospital, Second Military Medical University from January 2011 to December 2014 was performed. The total age of the patients was 6 to 68 years. The total body surface area , TBSA) 10% ~ 40%. According to the different treatment methods, the patients were divided into two groups, 10 cases in each group. The patients in control group were treated with debridement and negative pressure drainage in the first stage, and skin grafting in the second stage. Negative pressure drainage, 5 ~ 7d after the replacement of negative pressure device to observe the degree of vascular basement, 12 ~ 14d after injury line grafting. The interval from debridement to skin grafting, healing time and healing quality of donor area, skin graft survival rate, healing time and healing quality of the two groups were calculated respectively. Results Compared with the control group, the interval from debridement to skin grafting in the treatment group was prolonged [(13.30 ± 2.06) d vs (7.90 ± 1.10) days, P <0.01], and the healing time in the donor site was shortened [(8.10 ± 0.99) (87.30 ± 5.27)% vs (4.40 ± 1.58 vs 7.80 ± 1.14, P <0.01), d (13.10 ± 1.10) d, P <0.01] 85.10 ± 5.53)%], and the healing time was (17.80 ± 1.14) d vs (18.70 ± 2.06) d and the quality of healing was 8.40 ± 1.07 vs 9.00 ± 1.05 respectively. There was no significant difference between the two groups (P> 0.05). Conclusion In the treatment of large avulsion during the early application of dermal scaffold combined with negative pressure drainage technology can avoid a week after injury around a large area to take the skin, less surgical damage to the body interference is small, to ensure that patients with stable course Early stage; at the same time through the vascularization of the stent itself can promote wound healing, reduce skin graft thickness required to shorten the donor area healing time and improve the quality of donor area healing.