Chen S, Zheng L W, Liu W, Chen Z H
Fujian Burn Medical Center, Department of Burns, Fujian Medical University Union Hospital, Fuzhou 350001, China.
Zhonghua Shao Shang Za Zhi. 2019 Aug 20;35(8):608-610. doi: 10.3760/cma.j.issn.1009-2587.2019.08.010.
To explore the clinical effects of artificial dermis combined with vacuum sealing drainage (VSD) and autologous split-thickness skin graft in repair of scar contracture deformity after extensive burn. A total of 8 patients with scar hyperplasia and contracture deformity on joint after healing of extensive burn were admitted to our hospital from August 2015 to August 2017. There were 5 females and 3 males aged 8 to 45 years with an average of 23 years. In the first stage operation, scar tissue on contracture site was removed, and the wound was covered by artificial dermis followed by continued VSD treatment. On 10-14 d after the first stage operation, the artificial dermis tissue formed, and the second stage autologous split-thickness skin grafting and continued VSD treatment were performed. Routine anti-scar therapy was carried out after healing of wounds. Time of wound healing after the second stage operation was recorded. Colour and texture of the split-thickness skin graft, scar formation condition of the donor site, and action condition of the operation site during follow-up were observed. The wounds of 8 patients were healed in 10-14 d after the second stage operation. During follow-up of 6-24 months, the split-thickness skin graft was with smooth surface and good elasticity, and the function of joint recovered well. The donor site in head healed well with no scar. Only pigmentation was left in the donor site of thigh, and scar was not obvious. The patients and their family members were satisfied. After application of artificial dermis combined with VSD and autologous split-thickness skin graft in repair of scar contracture deformity after extensive burn, the skin grafting area and donor site were with unobvious scar hyperplasia, and the joint function in the operation area was good.
探讨人工真皮联合封闭式负压引流(VSD)及自体中厚皮片移植修复大面积烧伤后瘢痕挛缩畸形的临床效果。2015年8月至2017年8月,我院共收治8例大面积烧伤愈合后关节部位瘢痕增生挛缩畸形患者。其中女性5例,男性3例,年龄8~45岁,平均23岁。一期手术切除挛缩部位瘢痕组织,创面覆盖人工真皮后持续行VSD治疗。一期手术后10~14 d,人工真皮组织形成,行二期自体中厚皮片移植并继续VSD治疗。创面愈合后进行常规抗瘢痕治疗。记录二期手术后创面愈合时间。观察随访期间中厚皮片的色泽、质地,供皮区瘢痕形成情况及手术部位功能情况。8例患者二期手术后10~14 d创面愈合。随访6~24个月,中厚皮片表面平整,弹性良好,关节功能恢复良好。头部供皮区愈合良好,无瘢痕形成。大腿供皮区仅遗留色素沉着,瘢痕不明显。患者及家属满意。应用人工真皮联合VSD及自体中厚皮片移植修复大面积烧伤后瘢痕挛缩畸形,植皮区及供皮区瘢痕增生不明显,手术区域关节功能良好。