Kitala Diana, Kawecki Marek, Klama-Baryła Agnieszka, Łabuś Wojciech, Kraut Małgorzata, Glik Justyna, Ryszkiel Ireneusz, Kawecki Marek P, Nowak Mariusz
Dr Stanisław Sakiel Centre for Burns Treatment, Siemianowice Śląskie, Poland.
Medical Rescue Institue of the Nursing and Medical Rescue Department, Faculty of Health Sciences, University of Bielsko-Biała, Poland.
Adv Clin Exp Med. 2016 Sep-Oct;25(5):923-929. doi: 10.17219/acem/61961.
Early application of autologous skin may lead to the loss of split thickness skin graft due to unclarified wound bed. Allogeneic skin grafts are performed on patients with extensive burn injuries after escharotomy, tangential excisions and deep debridement for the purpose of stabilizing the general condition and reducing the scope of local complications.
The aim of this paper is to determine how the use of allografts improves the conditions for the intake of autografts in burns treatment, and how it accelerates wound healing in comparison to the autografts-only option.
In 2012-2013, allogeneic skin was grafted on 46 patients, and in 8 cases grafting was repeated several times. An autologous split-thickness skin graft was applied to 32 patients. The analysis included the relationship between the duration of hospitalization and the number of skin transplantations, the relationship between the time of admission to debridement of the necrotic tissues and the total duration of hospitalization. Statistical analysis encompassed also pain assessment.
The results suggest that multiple applications of autografts not only do not lead to quicker recovery, but even lengthen the hospitalization time. The dependency is visible also in the patients who underwent the skin grafting procedure in allogeneic and autologous systems twice or more. There was a statistical significant difference between the duration of hospitalization in groups of patients who underwent STSG preceded by allogeneic skin graft transplantation when compared to the group of patients who underwent allogeneic skin application (p < 0.05) and the group of patients who were grafted with autologous skin (p < 0.05).
Allogeneic skin grafts are a perfect dressing when wound vascularization is insufficient to take free split-thickness skin graft. In patients with comparable burn surface areas, multiple applications of free autologous split-thickness skin grafts (STSG) extend the hospitalization time in comparison to application of allogeneic skin dressing as the first-line therapy.
由于创面基底情况不明，早期应用自体皮可能导致中厚皮片移植失败。对于广泛烧伤患者，在焦痂切开、削痂和深度清创后进行异体皮移植，目的是稳定全身状况并减少局部并发症的范围。
本文旨在确定异体皮的使用如何改善烧伤治疗中自体皮移植的条件，以及与仅使用自体皮的方案相比，其如何加速伤口愈合。
2012年至2013年，46例患者接受了异体皮移植，其中8例重复移植多次。32例患者接受了自体中厚皮片移植。分析包括住院时间与皮肤移植次数的关系、坏死组织清创入院时间与住院总时长的关系。统计分析还包括疼痛评估。
结果表明，多次应用自体皮不仅不会导致更快康复，反而会延长住院时间。在接受异体和自体皮肤移植手术两次或更多次的患者中也可见这种相关性。与接受异体皮肤移植的患者组（p < 0.05）和接受自体皮肤移植的患者组（p < 0.05）相比，在接受异体皮肤移植后进行自体中厚皮片移植的患者组中，住院时间存在统计学显著差异。
当伤口血管化不足以接受游离中厚皮片移植时，异体皮移植是一种理想的敷料。在烧伤面积相当的患者中，与将异体皮肤敷料作为一线治疗方法相比，多次应用游离自体中厚皮片移植会延长住院时间。
