Chaouat M, Zakine G, Mimoun M
Service de chirurgie plastique, hôpital Rothschild, 33, boulevard de Picpus, 75012 Paris, France.
Pathol Biol (Paris). 2011 Jun;59(3):e57-61. doi: 10.1016/j.patbio.2009.12.003. Epub 2010 Feb 8.
The deep burns require a surgical treatment. The third degree circular burns require escharotomies and sometimes fasciotomies to avoid vascular compression. Early burn wound excision permits to remove the necrotic tissue that produce toxins and encourage infection. Wound coverage by an autologous split-thickness skin grafting, meshed or not, usually leads to a correct scar quality. In severe burns, when donor's sites are limited, the homografts permit to pass a critical stage even though they are rejected secondarily. The keratinocytes culture remains a difficult and exceptional technique for very severe burns permitting to save their life but with poor cosmetic results. Artificial dermal substitute could sometimes permit to replace the homograft and to improve the cosmetic results of the grafts by a better reconstitution of skin. If early burn wound excision with autologous split-thickness skin grafting remains the gold standard, the tissue-engineering will be a future way for the surgical treatment of the burns.
深度烧伤需要手术治疗。三度环形烧伤需要进行焦痂切开术，有时还需要进行筋膜切开术以避免血管受压。早期烧伤创面切除有助于清除产生毒素并易引发感染的坏死组织。采用自体中厚皮片移植进行创面覆盖，无论是否为网状移植，通常都会形成质量良好的瘢痕。在严重烧伤中，当供皮区有限时，同种异体移植即使会继发排斥反应，也能帮助患者度过关键阶段。角质形成细胞培养对于极重度烧伤而言仍是一项困难且特殊的技术，虽能挽救患者生命，但美容效果欠佳。人工真皮替代物有时可替代同种异体移植，并通过更好地重建皮肤来改善移植后的美容效果。如果早期烧伤创面切除并自体中厚皮片移植仍是金标准，那么组织工程将成为烧伤手术治疗的未来发展方向。
