探讨异体脱细胞真皮在手部深度烧伤创面治疗中的应用效果。

将2005年5月至2017年3月间解放军联勤保障部队第九〇六医院(原113医院)烧伤整形科收治的符合入选标准的62例(124只手)手部深度烧伤患者，按随机数字表法分为复合皮组和单纯自体刃厚皮组，每组各31例、62只手。复合皮组采用异体脱细胞真皮支架加自体大张刃厚皮片移植，单纯自体刃厚皮组采用单纯自体刃厚皮片大张移植，观察术后皮片成活、手部功能、瘢痕增生及外观恢复情况，电话、微信随访0.5～1.0年。数据比较采用Fisher确切概率法。

复合皮组31例(62只手)患者术后整体手部外形平整、丰满、耐压、抗磨擦，全部未行二次瘢痕整形手术。单纯自体刃厚皮组31例(62只手)患者，术后整体手部外观平整度差，不丰满、弹性差、不耐压、抗磨擦差，舒展性差。复合皮组患者术后瘢痕轻度增生60只手，重度增生2只手；单纯自体刃厚皮组瘢痕轻度增生12只手，重度增生50只手，2组比较差异有统计学意义(P值均小于0.05)；复合皮组患者术后手部功能恢复良好62只手，恢复差0只手，单纯自体刃厚皮组患者手部功能恢复良好4只手，恢复差58只手，2组比较差异有统计学意义(P值均小于0.05)。单纯自体刃厚皮组16例(32只手)患者再次作整形修复手术，修复后10例关节活动没有彻底恢复正常。另外13例(26只手)也有不同程度关节活动障碍，但未作整形修复手术。

异体脱细胞真皮作支架可以有效地保证修复创面植皮外观(平整度、丰满度、耐压、抗磨擦、弹性、舒展性)，最大限度恢复手部活动功能，疗效确切，并且供皮区恢复好，有好的临床应用价值，值得推广应用。

To investigate the effect of allogeneic acellular dermis on the treatment of deep burn wounds in the hand.

From May 2005 to March 2017, 62 cases (124 hands) of patients with deep burns who met the inclusion criteria in the Department of Burns and Plastic Surgery, 906th Hospital of the People′s Liberation Army Joint Service Support Unit (formerly 113 Hospital) were selected. According to the random number table method, patients were divided into a composite skin group and a simple autologous blade thick skin group, each group had 31 cases and 62 hands. The composite skin group was treated with allogeneic acellular dermal scaffold plus autologous large blade thick skin graft. The autologous blade thick skin group was transplanted with autologous blade thick skin graft. The postoperative skin survival, hand function, scar hyperplasia and appearance recovery were observed. The telephone and WeChat were followed up for 0.5 to 1.0 years. Data were compared with Fisher′s exact probability method.

In 31 patients (62 hands) of the composite skin group, the overall hand shape was flat, full, pressure-resistant and anti-friction. All of them didn′t undergo secondary scar plastic surgery. In 31 patients (62 hands) with simple autologous blade thick skin group, the overall hand appearance was poor in flatness, not fullness, poor elasticity, no pressure resistance, poor abrasion resistance and poor stretchability. In the composite skin group, 60 patients with mild hyperplasia after operation and 2 patients with severe hyperplasia; 12 patients with mild hyperplasia of scar and 50 patients with severe hyperplasia in the simple autologous blade thick skin group, the difference between the two groups was statistically significant (with P values below 0.05). In the composite skin group, the hand function recovered well in 62 hands, and the recovery was 0 hands. The hand function of the simple autologous blade thick skin group recovered well in 4 hands, and the functional recovery was poor in 58 hands. the difference between the two groups was statistically significant (with P values below 0.05). Sixteen patients (32 hands) in the simple autologous blade thick skin group underwent plastic surgery again, and 10 cases′ joint activities did not completely return to normal. In addition, 13 patients (26 hands) also had different degrees of joint movement disorder, but no plastic surgery was performed.

Allogeneic acellular dermal scaffold can effectively guarantee the appearance of skin grafting for wound repair (flatness, fullness, pressure resistance, abrasion resistance, elasticity, extensibility), and restore the function of hand movement to the maximum extent. The therapeutic effect is exact, and the donor skin area is recovered well, which has good clinical application value and is worth popularizing.