Lamy J, Yassine A-H, Gourari A, Forme N, Zakine G
Service de chirurgie plastique reconstructrice et esthétique, centre des brûlés, hôpital Trousseau, CHRU de Tours, 37044 Tours cedex 9, France.
Service de chirurgie plastique reconstructrice et esthétique, centre des brûlés, hôpital Trousseau, CHRU de Tours, 37044 Tours cedex 9, France; Cabinet, 33, rue de la Tour, 75016 Paris, France.
Ann Chir Plast Esthet. 2015 Apr;60(2):131-9. doi: 10.1016/j.anplas.2013.09.002. Epub 2013 Oct 30.
Progress in intensive care and surgery has made it possible to significantly improve the survival of victims with burns over 60% of total body surface area (TBSA). Coverage of the excised areas of these patients can be difficult when there is a shortage of skin donor sites; then the role of skin substitutes can be important.
This retrospective study included patients with burns covering more than 60% TBSA and treated at the Tours University Hospital over a period of 10 years. Patients who died during the first week or who presented superficial burns were excluded. The various substitutions means to temporarily or permanently replace the cutaneous barrier are presented. The biological dressings associated with grafts expanded by six according to the sandwich technique, allografts and xenografts, widely expanded postage stamp skin grafts using a modified Meek technique (Humeca(®)), temporary cutaneous substitutes such as Biobrane(®) and skin substitutes colonized by autologous cells (Integra(®)) are presented.
Forty-four patients were admitted. Self-immolations represented 52% of the cases. Twenty-one patients were treated with Integra(®), 5 with Biobrane(®), 17 with sandwich grafts and 4 with postage stamp skin grafts. Integra(®) was widely used when donor sites were insufficient. The mean number of surgical procedures per patient was 8.4. The mean duration of hospitalization was 155 days. Twenty-four patients survived until the end of treatment. Eighteen patients died during the first week before any surgery could be performed. Two patients died at the end of treatment. The overall survival rate was 55%. It was 92% for patients who survived the first week. The principal sequel were functional (hand, cervical, thoracic and axillary contractures) and aesthetic (face and hands). Associated treatments were pressotherapy, physical therapy, ergotherapy and thermal water therapy.
By temporarily replacing the cutaneous barrier in the absence of sufficient donor sites, skin substitutes make it possible to increase the survival of patients with very extensive burns and to optimize their treatment.
重症监护和外科手术的进展使全身表面积（TBSA）超过60%的烧伤患者的存活率得到显著提高。当皮肤供区不足时，覆盖这些患者的切除区域可能会很困难；此时皮肤替代物的作用就很重要。
这项回顾性研究纳入了10年间在图尔大学医院接受治疗的TBSA超过60%的烧伤患者。排除在第一周内死亡或为浅表烧伤的患者。介绍了用于临时或永久替代皮肤屏障的各种替代方法。介绍了与采用三明治技术扩展六倍的移植相关的生物敷料、同种异体移植物和异种移植物、使用改良米克技术（Humeca(®)）的广泛扩展邮票状皮肤移植、临时皮肤替代物如Biobrane(®)以及自体细胞定植的皮肤替代物（Integra(®)）。
44例患者入院。自伤占病例的52%。21例患者接受Integra(®)治疗，5例接受Biobrane(®)治疗，17例接受三明治移植，4例接受邮票状皮肤移植。当供区不足时，Integra(®)被广泛使用。每位患者的平均手术次数为8.4次。平均住院时间为155天。24例患者存活至治疗结束。18例患者在能够进行任何手术之前的第一周内死亡。2例患者在治疗结束时死亡。总生存率为55%。第一周存活的患者生存率为92%。主要后遗症为功能方面（手部、颈部、胸部和腋窝挛缩）和美观方面（面部和手部）。相关治疗包括压力疗法、物理疗法、职业疗法和温泉水疗法。
在没有足够供区的情况下，皮肤替代物通过临时替代皮肤屏障，使大面积烧伤患者的存活率得以提高，并优化其治疗。
