探讨瘢痕松解后一期创面负压吸引结合二期自体中厚皮片移植在特重度烧伤康复患者后期功能重建中的临床效果。

选取2015年7月至2016年7月江苏大学附属昆山医院烧伤整形外科收治的昆山"8·2"事件中特重度烧伤后期康复患者36例，所有患者烧伤面积均大于80%总体表面积，Ⅲ度烧伤面积均大于50%总体表面积，瘢痕面积均大于50%烧伤面积，烧伤后功能部位瘢痕挛缩(36处)受限。根据患者采用的治疗方式不同将患者分为实验组和常规手术组，每组18例。实验组患者行一期手术功能部位瘢痕松解后，创面持续负压吸引6 d，如创面基底良好，行二期创面自体中厚皮片移植修复创面，术后定期换药；常规手术组患者行功能部位瘢痕松解后，一期自体中厚皮片移植修复，术后定期换药。术后12 d，观察2组患者创面感染情况并计算2组自体皮成活率；记录植皮区植皮术后创面愈合时间及术后3、6、10个月植皮区瘢痕评分差值；术后12个月随访，对患者功能部位功能恢复情况进行评定。数据比较采用t检验、Wilcoxon秩和检验、χ²检验和Fisher确切概率法检验。

术后12 d，实验组患者自体皮成活率(94.28±3.58)%，高于常规手术组(89.06±3.89)%，差异有统计学意义(t＝4.245，P<0.05)；实验组出现1例感染，与常规手术组感染例数(3例)接近，差异无统计学意义(P＝0.603)。植皮术后，实验组患者植皮区创面平均愈合时间为(13.22±0.55) d，短于常规手术组(16.44±0.57) d，差异有统计学意义(t＝6.462，P＝0.0001)。实验组患者术后3、6、10个月植皮区瘢痕评分差值分别为(4.22±0.89)、(4.72±0.23)、(6.11±0.29)分，均低于常规手术组(5.00±0.59)、(6.78±0.24)、(8.22±0.31)分，差异有统计学意义(t＝2.830、7.857、6.008，P值均小于0.05)。术后12个月随访，实验组患者功能部位功能恢复情况：好10例，较好7例，差1例；常规手术组功能恢复情况：好5例，较好9例，差4例，实验组功能改善情况优于常规手术组，差异有统计学意义(χ²＝6.210，P＝0.045)。

瘢痕松解后创面负压吸引结合二期自体中厚皮片移植可提高皮片存活率、缩短创面愈合时间、改善植皮区瘢痕、改善功能部位活动情况，有较好的临床功能重建效果。

To investigate the clinical effect of the first-stage wound vacuum suction after the release of scar, combined with the second-stage autologous medium-thickness skin graft in the functional reconstruction of severe burns.

Thirty-six patients with severe burns in the Kunshan "8·2" incident admitted to the Department of Burns and Plastic Surgery, Affiliated Kunshan Hospital of Jiangsu University from July 2015 to July 2016 were selected. All patients had a burn area greater than 80% of the total body surface area, the full thickness burn area was larger than 50% of the total body surface area, scar area was greater than 50% of the burn area, and the scarring of the functional site after burn (36 places) was limited. Patients were divided into experimental group and conventional surgery group according to different treatment methods used by patients, 18 cases in each group. In the experimental group, after the operation of the functional site scar release, the wound was continuously given negative pressure suction for 6 days. If the base of the wound was good, the second-stage was treated with autologous medium-thickness skin graft to repair the wound, and the dressing was changed regularly. In the conventional surgery group, after the functional site scar was released, the first-stage autologous skin graft was repaired and the dressing was changed regularly. On the 12 d after operation, the wound infection status of the two groups was observed and the survival rate of the two groups was calculated. The wound healing time after skin grafting in the skin grafting area and the scar score difference of the skin grafting area at 3, 6 and 10 months after operation were recorded. The functional recovery of the functional part of the patient was evaluated at 12 months postoperatively. Data were compared using t test, Wilcoxon rank sum test, χ² test and Fisher exact probability method.

On the 12 d after operation, the survival rate of autologous skin in the experimental group was (94.28±3.58)%, which was higher than that in conventional surgery group (89.06±3.89)%, the difference was statistically significant (t=4.245, P<0.05). There was 1 case infection in the experimental group and 3 cases in the conventional surgery group, the difference was no statistically significant (P=0.603). After skin grafting, the average healing time of the skin grafting area in the experimental group was (13.22±0.55) d, which was less than that in the conventional surgery group (16.44±0.57) d, the difference was statistically significant (t=6.462, P=0.0001). The scores of the scar in the skin grafting area of the experimental group were (4.22±0.89), (4.72±0.23), and (6.11±0.29)points at 3, 6 and 10 months after operation, respectively, which were lower than those of the conventional surgery group [(5.00±0.59), (6.78±0.24), (8.22±0.31) points], the differences were statistically significant (t=2.830, 7.857, 6.008; with P values below 0.05). After 12 months of follow-up, the functional recovery of the functional parts of the experimental group: best for 10 cases, better for 7 cases, poor 1 cases; conventional surgery group function recovery: best 5 cases, better 9 cases, poor for 4 cases. The improvement of the function of the experimental group was better than that of the conventional surgery group. The difference was statistically significant (χ²=6.210, P=0.045).

After the scar is released, the vacuum suction of the wound combined with the second-stage autologous skin graft can improve the survival rate of the skin, shorten the wound healing time, improve the scar in the skin graft, improve the activity of the functional parts, and have better clinical function reconstruction effect.