切线切除烧伤焦痂的组织学评估。
Histological assessment of tangentially excised burn eschars.
作者信息
Gurfinkel Reuven, Rosenberg Lior, Cohen Sarit, Cohen Arnon, Barezovsky Alex, Cagnano Emanuela, Singer Adam J
机构信息
Department of Plastic & Reconstructive Surgery, The Burn Unit;
出版信息
Can J Plast Surg. 2010 Fall;18(3):e33-6.
BACKGROUND
The burn eschar serves as a medium for bacterial growth and a source of local and systemic infection. To prevent or minimize these complications, it is important to debride the eschar as early as possible.
OBJECTIVE
To identify the presence of viable skin within the excisions by examining tangentially excised burn eschars.
METHODS
A total of 146 samples of burned human tissue were removed during 54 routine sharp tangential excision procedures (using dermatomes). The samples were histologically examined to identify the relative thickness of the dead, intermediate and viable layers.
RESULTS
The mean (± SD) thickness of the excised samples was 1.7±1.1 mm. The sacrificed viable tissue (mean thickness 0.7±0.8 mm) occupied 41.2% of the entire thickness of the excision. In 32 biopsies (21.8%; 95% CI 16.0 to 29.3), the excision did not reach viable skin. Only eight biopsies (5.4%; 95% CI 2.8 to 10.1) contained all of the necrotic tissue without removing viable tissue.
CONCLUSIONS
The thickness of a single tangentially excised layer of eschar is not much greater than the actual thickness of the entire skin and often contains viable tissue. Because surgical debridement is insufficiently selective, more selective means of debriding burn eschars should be explored.
背景
烧伤焦痂是细菌生长的培养基，也是局部和全身感染的来源。为预防或尽量减少这些并发症，尽早切除焦痂很重要。
目的
通过检查切痂切除标本确定切除标本内是否存在存活皮肤。
方法
在54例常规锐性切痂手术（使用皮刀）中，共切除146份烧伤人体组织标本。对标本进行组织学检查，以确定坏死层、中间层和存活层的相对厚度。
结果
切除标本的平均（±标准差）厚度为1.7±1.1mm。牺牲的存活组织（平均厚度0.7±0.8mm）占切除标本总厚度的41.2%。在32份活检标本中（21.8%；95%可信区间16.0至29.3），切除未到达存活皮肤。只有8份活检标本（5.4%；95%可信区间2.8至10.1）包含所有坏死组织而未切除存活组织。
结论
单次切痂切除层的厚度并不比全层皮肤的实际厚度大多少，且常包含存活组织。由于手术清创的选择性不足，应探索更具选择性的烧伤焦痂清创方法。
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