Song Guodong, Jia Jun, Ma Yindong, Shi Wen, Wang Fang, Li Peilong, Gao Cong, Zuo Haibin, Fan Chunjie, Xin Naijun, Wu Qiuhe, Shao Yang
Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
Burns. 2016 Feb;42(1):71-80. doi: 10.1016/j.burns.2015.06.012. Epub 2015 Nov 3.
For adult patients with extensive full-thickness burns (EFTB), a fascial excision is mostly used but it causes a very significant deformity. This study aims to summarize experience and efficacy of surgery for retaining viable subcutaneous tissue in EFTB.
Clinical data were reviewed for 31 consecutive adult patients with full-thickness burn (FTB) over 70% total body surface area (TBSA) and undergoing first tangential excision and skin grafting on subcutaneous tissue wound (TESGSTW) within 7 days post burn at our burn center between 2002 and 2013.
Average age, total burn area, and FTB area of 31 patients were 32.4 ± 12.8 years, 89.0 ± 6.2% and 80.4 ± 7.6% TBSA, respectively. Of these, 80.6% combined with inhalation injury and 71.0% supervened early shock. Eighteen patients who survived (58.1%) totally underwent 121 times of surgery, of which TESGSTW and autologous skin grafting were 41 and 88 times, respectively. Their average time and area of first tangential excision was 4.1 ± 0.6 days post burn and 33.8 ± 7.6% TBSA, respectively, and accumulated tangential excision area was 58.4 ± 10.8% TBSA. In 39 times of TESGSTW within 14 days post burn, cryopreserved alloskin or fresh young pigskin was applied on 84.6%, and average time and take rate of autologous skin grafting instead of grafted alloskin or xenoskin was 14.6 ± 0.7 days and 89.5 ± 1.4%, respectively. Scalp was the main donor site for autologous skin, especially microskin grafting. Systemic wound healing time roughly was 67.3 ± 1.9 days post burn, meanwhile, viable subcutaneous tissue was retained. Healed wounds were plump, and their extensibility and sensitivity were better by follow-up.
The surgical treatment in EFTB is practicable and effective.
对于成年大面积全层烧伤（EFTB）患者，多采用筋膜切除，但会导致严重畸形。本研究旨在总结保留EFTB患者存活皮下组织手术的经验及疗效。
回顾性分析2002年至2013年期间在我院烧伤中心接受治疗的31例成年全层烧伤（FTB）患者的临床资料，这些患者烧伤总面积超过70%，伤后7天内接受首次削痂并在皮下组织创面植皮（TESGSTW）。
31例患者的平均年龄、烧伤总面积和FTB面积分别为32.4±12.8岁、89.0±6.2%和80.4±7.6%TBSA。其中，80.6%合并吸入性损伤，71.0%发生早期休克。18例存活患者（58.1%）共接受手术121次，其中TESGSTW和自体皮移植分别为41次和88次。首次削痂的平均时间和面积分别为伤后4.1±0.6天和33.8±7.6%TBSA，累计削痂面积为58.4±10.8%TBSA。在伤后14天内的39次TESGSTW中，84.6%应用了深低温保存的同种异体皮或新鲜幼猪皮，自体皮移植替代异体皮或异种皮移植的平均时间和成活率分别为14.6±0.7天和89.5±1.4%。头皮是自体皮的主要供区，尤其是微粒皮移植。全身创面愈合时间约为伤后67.3±1.9天，同时保留了存活的皮下组织。随访显示，愈合创面饱满，其延展性和感觉功能较好。
EFTB的手术治疗可行且有效。
