初步探究全厚微粒皮移植治疗自身免疫病相关性溃疡的临床疗效。

对2018年1月至2024年6月空军军医大学空军特色医学中心烧伤整形外科收治的28例自身免疫病（AID）相关性溃疡患者资料进行回顾性分析。患者入院后均行创面负压引流、清创换药治疗，至创面清洁、细菌培养阴性后接受植皮治疗，其中11例患者行全厚微粒皮移植，17例患者行刃厚皮移植。统计和对比两种植皮方法手术时长、供皮区术后24 h出血量（肉眼可见的血液浸透的纱布层数）、供皮区首次换药时疼痛程度［视觉模拟评分（VAS）］、植皮区及供皮区愈合时间、植皮区和供皮区愈合后6个月温哥华瘢痕量表（VSS）评分和患者治疗满意度（通过Likert 5 评分量表评估）。

全厚微粒皮移植组手术时长［2 （1.5，2.0） h］与刃厚皮移植组［2 （1.5，2.0） h］相比差异无统计学意义（P>0.05）；24 h出血量全厚微粒皮移植组［（2.10±0.82）层］显著低于刃厚皮移植组［（12.27±3.71）层］（t=8.896，P<0.001）；同时供皮区首次换药时全厚微粒皮移植组VAS评分［（2.24±0.41）分］显著低于刃厚皮移植组［（6.51±1.23）分］（t=11.059，P<0.001）；而全厚微粒皮移植组供皮区愈合时间［（10.45±1.56）d］较刃厚皮移植组［（19.48±3.75）d］明显缩短（t=7.536，P<0.001），但全厚微粒皮移植组创面愈合时间为［（32.13±5.79）d］长于刃厚皮移植组［（25.53±7.37） d］（t=2.506，P<0.05）；全厚微粒皮移植组的愈后6个月创面VSS评分为（3.18±1.37）分，显著低于刃厚皮移植组（4.52±1.06）分（t=2.913，P<0.01）。全厚微粒皮移植组的愈后6个月供皮区VSS评分为（2.31±1.19）分，低于刃厚皮移植组（4.11±1.42）分（t=3.481，P<0.01）。两组患者治疗满意度差异无统计学意义（P>0.05）。

全厚微粒皮移植治疗AID相关性溃疡时具有微创、经济、简便的优势，可显著降低供区疼痛和出血，加速供区愈合速度，减轻供区和创面愈合后瘢痕，患者对该手术方案满意度高，具有进一步研究和推广的价值。

To investigate the clinical efficacy of full-thickness microskin grafting in the treatment of autoimmune disease-related ulcers.

A retrospective study was conducted on 28 patients with autoimmune disease-related ulcers admitted to the Department of Burns and Plastic Surgery, Air Force Medical Center from January 2018 to June 2024. All patients were treated with wound vacuum drainage， debridement and dressing change after admission， and skin grafting was performed when the wound was clean and bacteria culture was negative， including 11 patients with full-thickness microskin grafting and 17 patients with split-thickness skin grafting. Statistically analyzed and compared the two skin grafting methods in terms of operation duration， postoperative 24 h blood loss at the skin donor site （the number of gauze layers visibly soaked with blood）， pain degree of skin donor site［visual analogue scale （VAS）］ at first dressing change， skin grafted area and skin donor site healing time， Vancouver scar scale （VSS） score at 6 months after healing of the skin grafted area and skin donor site， and patient treatment satisfaction （evaluated by Likert 5-point scale）.

There was no significant difference in the operation time between the full-thickness microskin grafting group 2 （1.5， 2.0） hours and the split-thickness skin grafting group 2 （1.5， 2.0） hours （P>0.05）. The blood loss in 24 h in the full-thickness microskin grafting group ［（2.10±0.82） layers］ was significantly lower than that in the split-thickness skin grafting group ［（12.27±3.71 ） layers］（t=8.896， P<0.001）. At the same time， the VAS score of full-thickness microskin grafting group ［（2.24±0.41） points］ was significantly lower than that of split-thickness skin grafting group ［（6.51±1.23）points］at the donor site at the first dressing change （t=11.059， P<0.001）. The healing time of donor site in full-thickness microskin grafting group ［（10.45±1.56）d］was significantly shorter than that in split-thickness skin grafting group ［（19.48±3.75）d］ （t=7.536， P<0.001）. The wound healing time in full-thickness microskin grafting group was （32.13±5.79） d, which was significantly higher than that of split-thickness skin grafting group （25.53±7.37 d） （t=2.506， P<0.05）. In 6 months after healing， the wound VSS score of full-thickness microskin group was （3.18±1.37）points， which was significantly lower than （4.52±1.06） points of split-thickness skin graft group （t=2.913， P<0.01）. The VSS of donor site in full-thickness microskin group was （2.31±1.19） points in 6 months after healing， which was much lower than （4.11±1.42） points in split-thickness skin graft group （t=3.481， P<0.01）. There was no significant difference in treatment satisfaction between the two groups （P>0.05）.

The full-thickness microskin grafting is minimally invasive， economical， and simple for the treatment of AID-related ulcers. It can significantly reduce pain and bleeding at the donor site， accelerate the healing of the donor site， and reduce scar at the donor site and wound after healing.