探讨改良足底取皮法治疗大面积深度烧伤患者的临床效果。

回顾性分析2018年1月至2024年8月解放军联勤保障部队第九一〇医院烧伤整形科收治符合入选标准的大面积深度烧伤患者65例，其中男45例，女20例，年龄18~80（41.83±0.22）岁。烧伤总面积30%~97%TBSA，Ⅲ度烧伤面积30%~85%TBSA。双足底采用常规方法或改良方法取皮1~4（1.8±0.9）次，将采用常规方法取皮1次的22例患者纳入常规组，采用改良方法取皮1次的21例患者纳入单次取皮组，采用改良方法取皮2~4次的22例患者纳入反复取皮组。改良方法包括供皮区去角质处理、负重区不取皮、扩大取皮范围、根据不同部位采用不同取皮刀具和取皮手法、供皮区应用创面敷料及采用邮票状刃厚皮移植等措施。末次取皮后，单次取皮组分别与常规组、反复取皮组末次取皮面积、术后7 d皮片成活率、供皮区愈合时间、术后6个月供皮区温哥华瘢痕量表（VSS）评分进行比较，同时计算22例反复取皮组患者相邻2次取皮的间隔时间，并通过术后6个月随访观察患者行走功能及供皮区并发症发生情况。

65例患者末次取皮后，常规组、单次取皮组与反复取皮组的末次取皮面积分别为1.5（1.0，1.8）%、3.8（3.0，4.0）%与3.7（3.5，4.0）%TBSA，单次取皮组高于常规组（U=443.500，P<0.001）。3组术后7 d皮片成活率分别为70.0（65.0，78.5） %、94.0（91.0，95.0） %与94.0（90.0，95.0）%，单次取皮组高于常规组（U=448.500，P<0.001）。3组供皮区愈合时间分别为14.0（13.0，16.0）、10.0（9.0，12.0）与10.0（10.0，11.0）d，单次取皮组低于常规组（U=20.500，P<0.001）。3组术后6个月供皮区VSS评分分别为4.0（4.0，5.0）、2.0（2.0，2.0）与2.0（2.0，2.0）分，单次取皮组低于常规组（U=11.500，P<0.001）。单次取皮组与反复取皮组比较，差异均无统计学意义（P>0.05）。22例反复取皮组患者相邻2次取皮间隔时间为10~45（12.5±0.5）d。术后6个月随访结果显示，全部患者行走无异常，供皮区无疼痛、破溃等并发症发生。

改良足底取皮法可增加足底取皮面积，提高皮片成活率，促进供皮区愈合，减少供皮区瘢痕及并发症，反复取皮不会影响疗效，可为大面积深度烧伤创面修复提供良好的自体皮源。

To investigate the clinical efficacy of the modified plantar skin harvesting technique in treating patients with extensive deep burns.

A retrospective analysis was conducted on 65 patients with extensive deep burn wounds admitted to the Department of Burns and Plastic Surgery of the 910th Hospital of the Joint Service Support Unit of PLA between January 2018 and August 2024，including 45 males and 20 females，aged 18–80 （41.83±0.22） years. The total burn area ranged from 30% to 97% TBSA，and the full-thickness burn area ranged from 30% to 85% TBSA. Skin harvesting from both soles was performed 1 to 4 （1.8±0.9） times using either conventional or modified methods. Among them，22 patients who underwent one session of skin harvesting using the conventional method were assigned to the conventional group，21 patients who underwent one session using the modified method were assigned to the single-harvest group，and 22 patients who underwent 2 to 4 sessions using the modified method were assigned to the repeated-harvest group. The modified technique included several measures，such as dekeratinization of the donor site，avoidance of skin harvesting from weight-bearing areas，expanded skin harvesting areas，use of different dermatomes and techniques based on the specific body region，application of wound dressings to the donor site，and postage stamp-style thin split-thickness skin grafting. After the final harvesting session，comparisons were made between the single-harvest group and the conventional group，as well as between the single-harvest group and the repeated-harvest group，in terms of the final skin harvesting area，skin graft survival rate at 7 days，donor site healing time，and Vancouver scar scale （VSS） scores at 6 months postoperation. Additionally，the intervals between two consecutive harvesting sessions were calculated for the 22 patients in the repeated-harvest group. Walking function and donor site complications were observed during a 6-month follow-up.

After the final skin harvesting session among the 65 patients，the harvested areas in the conventional group，single-harvest group and repeated-harvest group were a median of 1.5 （1.0，1.8）%，3.8 （3.0，4.0）% and 3.7 （3.5，4.0） %TBSA respectively. The single-harvest group showed a significantly larger harvested area than the conventional group （U=443.500，P<0.001）. The skin graft survival rates at 7 days for the three groups were a median of 70.0 （65.0，78.5） %，94.0 （91.0，95.0） % and 94.0 （90.0，95.0）% respectively，with the single harvest group being higher than the conventional group （U=448.500，P<0.001）. The donor site healing times for the three groups were a median of 14.0 （13.0，16.0），10.0 （9.0，12.0） and 10.0 （10.0，11.0） days respectively，with the single harvest group being shorter than the conventional group （U=20.500，P<0.001）. The VSS scores of donor sites at 6 months post-operation for the three groups were a median of 4.0 （4.0，5.0），2.0 （2.0，2.0） and 2.0 （2.0，2.0） points，respectively，with the single-harvest group being lower than the conventional group （U=11.500，P<0.001）. No statistically significant differences were observed between the single-harvest group and the repeated-harvest group in any of the above indicators （P>0.05）. The interval between two consecutive skin harvests in 22 patients in the repeated-harvest group ranged from 10 to 45 （12.5±0.5） days. During the 6-month follow-up，all patients exhibited normal gait，and no complications such as pain or ulceration at the donor site were observed.

The modified plantar skin harvesting method can increase the harvested skin area from the soles，improve skin graft survival rate，promote donor site healing，and reduce scarring and complications at the donor site. Repeated harvesting does not affect the therapeutic efficacy，providing an excellent autologous skin source for the repair of extensive deep burn wounds.