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目的:观察延期断层浅筋膜创面(脂肪层)皮肤移植术治疗大面积Ⅲ度烧伤的临床效果。方法:对16例大面积深度烧伤创面行早期(1～3 d)削痂术,滚轴刀削除创面坏死组织至健康的浅筋膜界面,行异体(种)皮移植过渡,以后根据异体(种)皮排异脱落、移植床血运重建和自体供皮情况,有计划的更植自体皮。观察患者总体治愈情况、创面愈合效果及创面愈合后的外观及功能情况。结果:本组患者共16例,无一例出现死亡,治愈率为100%。于术后2～3周创面愈合,多数瘢痕较轻,外形饱满,功能满意。功能部位植入大张皮片有3例出现局灶性坏死,通过换药愈合创面。少部分小皮片坏死,皮片间的肉芽组织过度生长,通过刮除高出的肉芽组织,并行换药治疗,创面愈合。随访16例功能部位植皮患者中,13例其皮肤外观、弹性及功能恢复良好,3例有轻、中度的功能障碍。结论:大面积Ⅲ度烧伤采用延期断层浅筋膜创面皮肤移植术,既可有效预防或减少并发症的发生,提高治愈率,又可减轻瘢痕形成,且功能部位早期得以良好修复,从而提高创面愈合质量。
Objective: To observe the clinical effect of skin grafting with superficial fascia (fat layer) skin grafting in the treatment of large-area third-degree burns. Methods: Twenty-six cases of deep burn wounds were treated with early (1-3 days) tangential excision and roller knife to remove necrotic tissue from the wound surface to the healthy superficial fascia membrane. Allograft transplants were performed. Species) Exfoliation, transplanted bed revascularization and autologous skin supply situation, a more planted autologous skin. Observe the overall patient’s healing, wound healing and wound healing appearance and function. Results: A total of 16 patients in this group, no case of death, the cure rate was 100%. The wounds healed 2 to 3 weeks after operation, most of the scars were lighter, the shape was full and the function was satisfied. Functional site implantation of large sheets of 3 cases of focal necrosis, wound healing by dressing. A small part of small skin necrosis, granulation tissue between the skin overgrowth, by scraping higher granulation tissue, parallel dressing, wound healing. Of the 16 patients with functional grafts who were followed up, 13 had good skin appearance, elasticity and functional recovery, and 3 had mild to moderate dysfunction. Conclusion: The skin grafting of superficial third fasciculus with delayed superficial fascia is effective in preventing and reducing the complications, improving the cure rate and reducing the scar formation. The functional site can be repaired early and the wound surface can be improved Heal quality.