探讨人工真皮联合富血小板纤维蛋白(PRF)修复小面积深度创面的临床疗效。

采用前瞻性随机对照研究方法。2018年1月至2021年12月，郑州市第一人民医院烧伤科收治40例符合入选标准的小面积深度创面患者，按区组随机化法将患者分为2组，每组20例。人工真皮组中男11例，女9例，年龄(43.10±4.54)岁，创面面积(35.85±5.64)cm² ；联合组中男13例，女7例，年龄(43.55±4.71)岁，创面面积(37.65±6.21)cm²。患者创面彻底清创后，人工真皮组外用人工真皮覆盖创面，联合组抽取患者静脉全血制备PRF填塞创面后，外用人工真皮覆盖创面，而后行规律换药。待肉芽组织生长覆盖创面后，对两组患者行Ⅱ期自体皮片移植术修复创面。记录患者换药次数、创面愈合时间。自体皮片移植术后第7天，计算皮片成活率。观察人工真皮下是否出现血肿及创面感染等不良反应。创面愈合后6个月，随访观察患者植皮区是否出现破溃，采用温哥华瘢痕量表(VSS)评价创面瘢痕生长情况。对数据行独立样本t检验、Mann-Whitney U检验和χ²检验。

联合组患者换药次数为(8.65±2.54)次，明显少于人工真皮组的(10.75±3.16)次(t＝2.316，P<0.05)；联合组患者创面愈合时间为(29.95±4.71)d，明显短于人工真皮组的(35.55±5.34)d(t＝3.520，P<0.05)。自体皮片移植术后第7天，联合组患者皮片成活率为(92.9±6.9)%，人工真皮组为(91.3±8.7)%，2组比较差异无统计学意义(t＝0.645，P>0.05)。两组患者人工真皮下均未出现血肿，未发生感染等不良反应。创面愈合后6个月，两组患者植皮区均未出现破溃；联合组患者创面VSS评分[5.00(4.00，6.00)分]低于人工真皮组[6.00(5.00，6.00)分]，差异有统计学意义(Z＝2.422，P<0.05)。

人工真皮联合PRF修复小面积深度创面的临床效果明显，可减少换药次数，缩短创面愈合时间，改善创面瘢痕增生情况。

To explore the clinical effects of artificial dermis combined with platelet-rich fibrin (PRF) in repairing small area deep wounds.

A prospective randomized controlled study was conducted. From January 2018 to December 2021, 40 patients with small area deep wounds who met the inclusion criteria were admitted to Department of Burns of Zhengzhou First People′s Hospital. According to the block randomization, the patients were divided into two groups, with 20 patients in each group. In artificial dermis group, there were 11 male and 9 female patients, aged (43.10±4.54) years, with the wounds area of (35.85±5.64)cm². In combination group, there were 13 male and 7 female patients, aged (43.55±4.71) years, with the wounds area of (37.65±6.21)cm². After the wound was completely debrided, artificial dermis was used to cover the wound in artificial dermis group, but in combination group, whole venous blood was extracted from patients to prepare PRF for wound packing and the wound was covered with artificial dermis. Then dressing change was conducted regularly. After the growth of granulation tissue covered the wound in both groups, autologous skin grafting was conducted to repair wounds in the second stage. The times of dressing change and wound healing time were recorded. The survival rate of skin flap on the 7th day after autologous skin grafting was calculated. The occurrence of hematoma under artificial dermis and adverse reactions such as wound infection were recorded. At 6 months after wound healing, the patients were followed up to observe whether the skin graft area was ruptured, and the scar was evaluated by Vancouver scar scale (VSS). Data were statistically analyzed with independent sample t test, Mann-Whitney U test, and chi-square test.

The times of dressing change in combination group was (8.65±2.54), significantly less than (10.75±3.16) in artificial dermis group (t=2.316, P<0.05). The wound healing time in combination group was (29.95±4.71) days, significantly shorter than (35.55±5.34) days in artificial dermis group (t=3.520, P<0.05). On the 7th day after autologous skin grafting, the survival rate of skin flap was (92.9±6.9)% in combination group, which was not significantly different from (91.3±8.7)% in artificial dermis group (t=0.645, P>0.05). There were no hematomas under artificial dermis and wound infection occurred in both groups. At 6 months after wound healing, there was no rupture in the skin grafting area of the two groups. The VSS score of the wound was 5.00(4.00, 6.00) in combination group, significantly lower than 6.00(5.00, 6.00) in artificial dermis group (Z=2.422, P<0.05).

Artificial dermis combined with PRF has obvious clinical effects in repairing small area deep wounds. It can significantly reduce the times of dressing change, shorten the healing time, and improve scar hyperplasia.