切换至 "中华医学电子期刊资源库"

中华损伤与修复杂志(电子版) ›› 2021, Vol. 16 ›› Issue (04) : 322 -325. doi: 10.3877/cma.j.issn.1673-9450.2021.04.007

论著

人工真皮联合自体刃厚头皮在修复儿童烧伤后肢体关节瘢痕挛缩中的临床应用效果
周雅静1, 侯玉森1, 李冬海1,(), 曹玉珏1, 余斌1, 张玉君1   
  1. 1. 100069 北京丰台右安门医院烧伤整形科
  • 收稿日期:2021-05-18 出版日期:2021-08-05
  • 通信作者: 李冬海

Clinical application effect of artificial dermis combined with autologous blade thick scalp in repairing limb joint scar contracture after burn in children

Yajing Zhou1, Yusen Hou1, Donghai Li1,(), Yujue Cao1, Bin Yu1, Yujun Zhang1   

  1. 1. Department of Burns and Plastic Surgery, Beijing Fengtai Youanmen Hospital, Beijing 100069, China
  • Received:2021-05-18 Published:2021-08-05
  • Corresponding author: Donghai Li
引用本文:

周雅静, 侯玉森, 李冬海, 曹玉珏, 余斌, 张玉君. 人工真皮联合自体刃厚头皮在修复儿童烧伤后肢体关节瘢痕挛缩中的临床应用效果[J]. 中华损伤与修复杂志(电子版), 2021, 16(04): 322-325.

Yajing Zhou, Yusen Hou, Donghai Li, Yujue Cao, Bin Yu, Yujun Zhang. Clinical application effect of artificial dermis combined with autologous blade thick scalp in repairing limb joint scar contracture after burn in children[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2021, 16(04): 322-325.

目的

探讨人工真皮联合自体刃厚头皮在修复儿童烧伤后肢体关节瘢痕挛缩中的临床应用效果。

方法

回顾性分析2017年3月至2020年3月北京丰台右安门医院烧伤整形科收治的儿童肢体关节部位烧伤后瘢痕挛缩23例。患儿于入院后完善术前常规化验及检查,一期手术切除瘢痕组织,矫正关节挛缩畸形,取与创面面积相同大小的人工真皮打孔并覆盖创面,采用含银抗菌敷料、纱垫、医用棉垫等适当加压包扎,石膏固定关节部位;围手术期予以抗生素预防感染;术后1周开始换药观察人工真皮血管化情况,2~3 d换药1次。术后2周人工真皮血管化,创基见类真皮组织,行二期手术取相同与创面大小刃厚头皮(厚度约0.2~0.3 mm)移植于创面,钉皮钉固定,用含银抗菌敷料、纱垫、医用棉垫等适当加压包扎供受区;植皮术后受区3 d开始换药,2~3 d换药1次;供皮区于术后5 d去除外层敷料,保留内层油性含银敷料,保持干燥待自然脱落愈合。术后观察人工真皮血管化和刃厚头皮存活情况,门诊或网络随访远期观察植皮区有无破溃、色泽、质地、瘢痕生长情况及关节功能。

结果

一期手术后除2例患儿因血肿或感染并发症致人工真皮脱落或溶解,经二次清创后再次覆盖人工真皮成功血管化外,其余21例均一次手术实现人工真皮血管化。二期手术植皮后,移植的23例刃厚头皮均存活;门诊或网络随访6~12个月,移植皮片未见破溃,色泽、质地均良好,无瘢痕增生,关节功能恢复满意。

结论

人工真皮联合自体刃厚头皮修复儿童烧伤后肢体关节瘢痕挛缩较皮瓣或全厚皮片修复创伤更小,疗效满意。

Objective

To investigate the clinical application effect of artificial dermis combined with autologous blade thick scalp in repairing limb joint scar contracture after burn in children.

Methods

A retrospective study was conducted on 23 children with scar contracture after burn in the joint of the limbs in Department of Burns and Plastic Surgery, Beijing Fengtai Youanmen Hospital from March 2017 to March 2020. Routine preoperative laboratory tests and examinations were completed after the patients were admitted to hospital. Scar tissue was removed in the first stage of surgery to correct joint contracture deformity. Artificial dermis of the same size as the wound area were taken to perforate and cover the wound, and the silver-containing antibacterial dressings, gauze pads, medical cotton pads, etc. were used to properly pressurize and plaster to fix the joints. Antibiotics were given to prevent infection during perioperative period. Dressing change was started 1 week after operation to observe the vascularization of the artificial dermis, and the dressing was changed once every 2 to 3 days. Two weeks after the operation, the artificial dermis was vascularized, and dermal tissue was found in the wound base. The second-stage operation was performed to transplant the blade thick scalp of the same size as the wound (thickness about 0.2-0.3 mm) onto the wound, fixed it with skin nails, and bandaged the donor and recipient areas with silver-containing antibacterial dressings, gauze pads, medical cotton pads, etc. The dressing was changed at the receiving area 3 days after skin grafting, and the dressing was changed once every 2 to 3 days; the outer dressing was removed from the donor area 5 days after the operation, and the inner oily silver dressing was retained, and kept dry until it fell off and healed naturally. The vascularization of the artificial dermis and the survival of the razor-edge thick scalp were observed after surgery. The outpatient or network follow-up was performed to observe the rupture, color, texture, scar growth and joint function of the grafted skin area in the long term.

Results

After the first operation, the artificial dermis was vascularized in all the other 21 cases, except 2 cases which were successfully vascularized by covering the artificial dermis again after the second debridement due to the loss or dissolution of the artificial dermis due to hematoma or infection complications. After the second stage of skin grafting, all the 23 patients with blade thick scalp survived. After 6 to 12 months of outpatient or network follow-up, the grafts showed no rupture, good color and texture, no scar hyperplasia, and satisfactory recovery of joint function.

Conclusion

Artificial dermis combined with autologous blade thick scalp to repair limb joint scar contracture after burn in children is less traumatic than skin flaps or full-thickness skins, and the effect is satisfactory.

图1 瘢痕松解切除+人工真皮植入术联合自体刃厚头皮移植修复左膝关节瘢痕挛缩畸形。A示患儿左侧腘窝瘢痕挛缩畸形,膝关节被动屈曲位;B示手术松解切除瘢痕至脂肪层,创面面积约6 cm×10 cm;C示将相同面积人工真皮打孔后移植覆盖于清创后创面;D示行人工真皮植入术2周后去除人工真皮表层硅胶膜,可见胶原蛋白海绵层血管化良好,创基可见类真皮组织;E示取相同面积自体刃厚头皮移植覆盖创面;F示门诊随访8个月后,植皮区表面平整无破溃,色泽、质地良好,未见瘢痕增生及挛缩
[1]
宋德恒,刘继松,郝擎宇,等. 人工真皮在整形外科中的应用[J]. 中国美容医学2018, 27(1): 137-140.
[2]
Yeong EK, Yu YC, Chan ZH, et al. Is artificial dermis an effective tool in the treatment of tendon-exposed wounds?[J]. J Burn Care Res, 2013, 34(1): 161-167.
[3]
Hamuy R, Kinoshita N, Yoshimoto H, et al. One-stage, simultaneous skin grafting with artificial dermis and basic fibroblast growth factor successfully improves elasticity with maturation of scar formation[J]. Wound Repair Regen, 2013, 21(1): 141-154.
[4]
季一发,闫利,俞松,等. 脱细胞异体真皮联合头刃厚皮修复儿童瘢痕创面[J]. 中华实用诊断与治疗杂志2017, 31(2): 156-158.
[5]
朱振洪,殷炜,马周瑞,等. 早期去除坏死皮肤结合人工真皮及皮片移植治疗儿童手部皮肤坏死性挫伤[J]. 临床小儿外科杂志2019, 18(11): 964-967.
[6]
董云飞,陶忠生,吴清华,等. 不同方法修复儿童足跟轮辐伤皮肤缺损伴跟腱外露[J]. 临床骨科杂志2021, 24(1): 64-67.
[7]
靳雪义,张宏,张岿. 人工真皮联合瘢痕断层皮片修复治疗在烧伤后四肢大关节部位瘢痕增生挛缩畸形患者中的应用[J]. 中国医疗美容2020, 10(12): 49-53.
[8]
王成,陈欣,沈余明,等. 人工真皮联合自体皮片修复创伤后骨和/或肌腱外露创面的临床研究[J]. 中国医刊2020, 55(12): 1334-1337.
[9]
吕振木,冯亚高,王秋生,等. 人工真皮修复手指末节软组织缺损[J]. 中华显微外科杂志2014, 37(6): 596-598.
[10]
王丽英,黄红军,牛希华. 人工真皮联合自体薄皮片移植和自体中厚皮移植治疗烧伤后增生性瘢痕的疗效比较[J]. 中国医疗美容2018, 8(2): 26-29.
[11]
弓辰,唐洪泰,王光毅,等. 国产人工真皮移植结合自体皮移植修复骨质肌腱外露创面的疗效评价[J/CD]. 中华损伤与修复杂志(电子版), 2016, 11(1): 34-39.
[12]
刘江涛,曾纯,欧阳容兰,等. 人工真皮+负压封闭引流技术+自体刃厚皮片移植联合修复复杂创面的临床应用[J/CD]. 中华损伤与修复杂志(电子版), 2020, 15(3): 215-218.
[13]
王延杰,陶忠生,霍飞,等. 急诊使用人工真皮覆盖修复指(趾)末节小面积皮肤软组织缺损[J]. 实用手外科杂志2015, 29(3): 320-321.
[14]
王永胜,邱健钊,李军,等. 人工真皮覆盖修复手足小面积创面的效果[J]. 临床骨科杂志2017, 20(1): 64-66.
[15]
Morimoto N, Kuro A, Yamauchi T, et al. Combined use of fenestrated-type artificial dermis and topical negative pressure wound therapy for the venous leg ulcer of a rheumatoid arthritis patient[J]. Int Wound J, 2016, 13(1): 137-140.
[1] 张璇, 马宇童, 苗玉倩, 张云, 吴士文, 党晓楚, 陈颖颖, 钟兆明, 王雪娟, 胡淼, 孙岩峰, 马秀珠, 吕发勤, 寇海燕. 超声对Duchenne肌营养不良儿童膈肌功能的评价[J]. 中华医学超声杂志(电子版), 2023, 20(10): 1068-1073.
[2] 张宝富, 俞劲, 叶菁菁, 俞建根, 马晓辉, 刘喜旺. 先天性原发隔异位型肺静脉异位引流的超声心动图诊断[J]. 中华医学超声杂志(电子版), 2023, 20(10): 1074-1080.
[3] 韩丹, 王婷, 肖欢, 朱丽容, 陈镜宇, 唐毅. 超声造影与增强CT对儿童肝脏良恶性病变诊断价值的对比分析[J]. 中华医学超声杂志(电子版), 2023, 20(09): 939-944.
[4] 刘婷婷, 林妍冰, 汪珊, 陈幕荣, 唐子鉴, 代东伶, 夏焙. 超声衰减参数成像评价儿童代谢相关脂肪性肝病的价值[J]. 中华医学超声杂志(电子版), 2023, 20(08): 787-794.
[5] 周钰菡, 肖欢, 唐毅, 杨春江, 周娟, 朱丽容, 徐娟, 牟芳婷. 超声对儿童髋关节暂时性滑膜炎的诊断价值[J]. 中华医学超声杂志(电子版), 2023, 20(08): 795-800.
[6] 罗晨, 宗开灿, 李世颖, 傅应亚. 微小RNA-199a-3p调控CD4T细胞表达参与肺炎支原体肺炎患儿免疫反应研究[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 569-574.
[7] 居晓庆, 金蕴洁, 王晓燕. 剖宫产术后瘢痕子宫患者再次妊娠阴道分娩发生子宫破裂的影响因素分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 575-581.
[8] 米洁, 陈晨, 李佳玲, 裴海娜, 张恒博, 李飞, 李东杰. 儿童头面部外伤特点分析[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 511-515.
[9] 李维, 莫俊俏. 儿童呼吸道耐药流感嗜血杆菌基因型鉴定及耐药分析对抗菌药物治疗选择的意义[J]. 中华实验和临床感染病杂志(电子版), 2023, 17(05): 315-323.
[10] 王蕾, 王少华, 牛海珍, 尹腾飞. 儿童腹股沟疝围手术期风险预警干预[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 768-772.
[11] 李芳, 许瑞, 李洋洋, 石秀全. 循证医学理念在儿童腹股沟疝患者中的应用[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 782-786.
[12] 吕垒, 冯啸, 何凯明, 曾凯宁, 杨卿, 吕海金, 易慧敏, 易述红, 杨扬, 傅斌生. 改良金氏评分在儿童肝豆状核变性急性肝衰竭肝移植手术时机评估中价值并文献复习[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 661-668.
[13] 卓少宏, 林秀玲, 周翠梅, 熊卫莲, 马兴灶. CD64指数、SAA/CRP、PCT联合检测在小儿消化道感染性疾病鉴别诊断中的应用[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 505-509.
[14] 刘笑笑, 张小杉, 刘群, 马岚, 段莎莎, 施依璐, 张敏洁, 王雅晳. 中国学龄前儿童先天性心脏病流行病学研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1021-1024.
[15] 李静, 张玲玲, 邢伟. 兴趣诱导理念用于小儿手术麻醉诱导前的价值及其对家属满意度的影响[J]. 中华临床医师杂志(电子版), 2023, 17(07): 812-817.
阅读次数
全文


摘要