探讨双层人工真皮联合自体刃厚皮移植修复烧创伤后骨/肌腱外露创面的临床效果。

选择2019年11月至2022年8月期间内蒙古包钢医院烧伤科收治的符合入选标准的60例烧创伤后骨/肌腱外露患者作为研究对象，对其病例资料进行回顾性分析。根据创面修复方法不同将患者分为对照组和观察组，每组各30例。患者入院后完善相关检查，常规应用青霉素类抗生素控制感染，根据创面细菌培养结果及药物敏感试验结果调整抗生素的应用。观察组患者Ⅰ期行手术清创及双层人工真皮移植；待人工真皮完全血管化后，Ⅱ期去除人工真皮的硅胶层，再次修整创面，移植自体刃厚皮片。对照组待创面具备植皮条件后行单纯皮瓣或皮片移植修复创面。比较2组患者皮片/皮瓣成活率和创面愈合率、住院时间及住院费用、瘢痕生长情况。数据比较采用t检验及χ²检验。

术后10 d，观察组患者创面植皮术区皮片均成活，皮下无淤血及积液，皮片成活率为100%；对照组4例皮片移植患者皮下淤血较明显，皮片溶解坏死，2例皮瓣移植患者部分皮瓣远端血运障碍，缺血坏死，皮片/皮瓣成活率为80%，2组比较差异有统计学意义(χ²＝4.63, P＝0.03)。术后28 d，观察组创面全部愈合，术区无渗液、无红肿，创面愈合率为100%；对照组有6例患者创面未完全愈合，创面愈合率为80%，2组比较差异有统计学意义(χ²＝4.63, P＝0.03)。观察组患者平均住院时间及平均住院费用分别为(28.31±3.39) d、(6.58±1.21)万元，对照组患者平均住院时间及平均住院费用分别为(35.42±4.22) d、(3.27±1.10)万元，2组比较差异均有统计学意义(t＝7.21、11.13, P<0.05)。术后6个月，观察组温哥华瘢痕量表评分为(4.72±1.93)分，对照组为(5.88±2.12)分，2组比较差异有统计学意义(t＝2.22, P<0.05)。

双层人工真皮联合自体刃厚皮移植修复烧创伤后骨/肌腱外露创面，皮片/皮瓣成活率及创面愈合率高，可缩短平均住院时间，术后瘢痕增生较轻，值得临床推广应用。

To investigate the clinical effect of double layer artificial dermis combined with autologous blade thick skin transplantation in repairing the exposed bone or tendon wounds after burn trauma.

Sixty patients with bone or tendon exposure after burn trauma admitted to the Department of Burn, Inner Mongolia Baogang Hospital from November 2019 to August 2022 meeting the inclusion criteria were selected as the research objects, and their case data were retrospectively analyzed. According to different wound repair methods, the patients were divided into control group and observation group, 30 cases in each group. After admission, relevant examinations were performed, penicillin antibiotics were routinely used to control infection, and antibiotic use was adjusted according to the results of wound bacterial culture and drug sensitivity test. Observation group received surgical debridement and double layer artificial dermal transplantation at stage Ⅰ; after the artificial dermis was completely vascularized, the silicone layer of the artificial dermis was removed in the stage Ⅱ, the wound was trimmed again, and the autologous thick blade skin was transplanted. The control group underwent simple skin flap or skin graft after the wound was equipped with skin grafting conditions. The survival rate of skin or flap, wound healing rate, hospital stay, hospital expenses and scar growth condition were compared between the 2 groups. Data were compared by t test and chi-square test.

Ten days after surgery, all the skin grafts in the observation group survived without subcutaneous congestion and effusion, and the survival rate of skin grafts was 100%; in the control group, 4 skin graft patients had obvious subcutaneous congestion, skin dissolution and necrosis, and 2 skin flap graft patients had partial flap distal blood circulation disorder and ischemic necrosis, the survival rate of skin/flap was 80%, the difference was statistically significant (χ²=4.63, P=0.03). Twenty-eight days after surgery, all wounds in the observation group were healed, and there was no effusion or redness in the operative area, and the wound healing rate was 100%; in the control group, 6 patients had incomplete wound healing, and the wound healing rate was 80%, the difference was statistically significant (χ²=4.63, P=0.03). The average length of hospital stay and the average hospital cost of stay in the observation group were (28.31±3.39) days and (6.58±1.21) yuan, respectively. The average length of hospital stay and the average hospital cost of stay in the control group were (35.42±4.22) days and (3.27±1.10) yuan, respectively. The differences between the 2 groups were statistically significant (t=7.21, 11.13; P< 0.05). Six months after surgery, the score of Vancouver scar scale was (4.72±1.93) points in the observation group and [(5.88±2.12) points] in the control group, and the difference between the 2 groups was statistically significant (t=2.22, P< 0.05).

The treatment of exposed bone/tendon wounds after burn trauma with double-layer artificial derma combined with autologous blade thick skin can improve the survival rate of skin/flap and the rate of wound healing, shorten the average length of hospital stay, and reduce postoperative scar hyperplasia, which is worthy of clinical application.