Greenwood John E
Adult Burn Service, Royal Adelaide Hospital, Adelaide, Australia.
Anaesth Intensive Care. 2020 Mar;48(2):93-100. doi: 10.1177/0310057X19895788. Epub 2020 Apr 1.
After major burn injury, once survival is achieved by the immediate excision of all deep burn eschar, we are faced with a patient who is often physiologically well but with very extensive wounds. While very early grafting yields excellent results after the excision of small burns, it is not possible to achieve the same results once the wound size exceeds the available donor site. In patients where 50%-100% of the total body surface area is wound, we rely on serial skin graft harvest, from finite donor site resources, and the massive expansion of those harvested grafts to effect healing. The result is frequently disabling and dysaesthetic. Temporisation of the wounds both passively, with cadaver allograft, and actively, with dermal scaffolds, has been successfully employed to ameliorate some of the problems caused by our inability to definitively close wounds early. Recent advances in technology have demonstrated that superior functional and cosmetic outcomes can be achieved in actively temporised areas even when compared with definitive early closure with skin graft. This has several beneficial implications for both patient and surgeon, affecting the timing of definitive wound closure and creating a paradigm shift in the care of the burned patient.
大面积烧伤后，一旦通过立即切除所有深度烧伤焦痂实现存活，我们面对的患者通常生理状况良好，但伤口范围非常广泛。虽然在切除小面积烧伤后尽早植皮能取得极佳效果，但一旦伤口面积超过可用供皮区，就无法达到同样的效果。在全身表面积50%-100%为伤口的患者中，我们依靠从有限的供皮区资源进行多次取皮，并对所取皮片进行大量扩张来实现愈合。结果往往是致残且感觉异常。被动使用尸体同种异体皮和主动使用真皮支架对伤口进行暂时处理，已成功用于缓解因我们无法早期彻底闭合伤口所导致的一些问题。技术上的最新进展表明，即使与早期用皮片进行确定性闭合相比，在积极进行暂时处理的区域也能实现更好的功能和美容效果。这对患者和外科医生都有几个有益的影响，影响确定性伤口闭合的时机，并在烧伤患者的护理方面引发了范式转变。
