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[关于深度烧伤创面患者的修复与康复的讨论]

[A discussion regarding reconstruction and rehabilitation of patients with deep burn wound].

作者信息

Hu Da-hai

机构信息

Department of Burns and Cutaneous Surgery, Xijing Hospital, the Fourth Military Medical University, Xi'an 710032, China.

出版信息

Zhonghua Shao Shang Za Zhi. 2009 Dec;25(6):401-3.

Abstract

With the advances in resuscitation, infection control, and metabolic management, the treatment strategies for burn patients have improved remarkably in the last half century. As a result, more patients with deep burn wound survived, and how to optimize the burn wound care aiming at recovery of the normal appearance and physiologic function of patients has been investigated and discussed widely through both the whole treatment strategy making and the new techniques performing. In the present discussion, early tissue reconstruction as well as early wound covering and repair are emphasized by summarizing the improved aesthetic and functional effects obtained by applying the principles of plastic surgery in early burn wound repair, the use of composite skin grafting, the grafting with split-thickness autografts on the preserved denatured dermis or on the preserved healthy fat tissue, etc. Besides these, more attention should be given to the repair and reconstruction in specialized functional parts of the body, such as head and face, neck, hand, female breast, perineum, and joint areas, after a deep burn. The role of rehabilitation during and after the burn wound treatment process is elucidated by demonstrating its potential biophysical mechanism and preventing scar deformity. Adequate treatment of deep burn wound demands a number of important measures including the timing of surgery, adoption of essential techniques, suitable types of wound covering materials, motivated rehabilitation, and necessary psychological therapy. The optimal recovery of damaged part of body after burn should depend on the similarity of rebuild tissue structure to simulate the nature of the original tissue in the cellular, histological, anatomic characteristics, which is the aim of all burn wound care and the basis of the appearance and function repair or reconstruction.

摘要

随着复苏、感染控制和代谢管理方面的进展,烧伤患者的治疗策略在过去半个世纪中有了显著改善。因此,更多深度烧伤创面的患者得以存活,并且通过制定整体治疗策略和应用新技术,针对如何优化烧伤创面护理以恢复患者正常外观和生理功能的问题展开了广泛研究与讨论。在当前的讨论中,通过总结在早期烧伤创面修复中应用整形外科学原理、使用复合皮移植、在保留的变性真皮或保留的健康脂肪组织上移植自体断层皮片等所获得的美学和功能改善效果,强调了早期组织重建以及早期创面覆盖与修复。除此之外,对于深度烧伤后身体特殊功能部位,如头面部、颈部、手部、女性乳房、会阴及关节部位的修复与重建应给予更多关注。通过揭示其潜在生物物理机制及预防瘢痕畸形,阐明了康复在烧伤创面治疗过程中和治疗后的作用。深度烧伤创面的充分治疗需要一系列重要措施,包括手术时机、采用必要技术、选用合适的创面覆盖材料、积极的康复治疗以及必要的心理治疗。烧伤后身体受损部位的最佳恢复应取决于重建组织结构在细胞、组织学、解剖学特征上与原始组织性质的相似性,这是所有烧伤创面护理的目标以及外观和功能修复或重建的基础。

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