From the Department of Surgery, Kendall Regional Medical Center, Miami.
Burn & Reconstructive Centers of Florida, Miami, FL.
Ann Plast Surg. 2020 Dec;85(6):618-621. doi: 10.1097/SAP.0000000000002414.
Genital burns have devastating effects on patient and have been classified by the American Burn Association as major burn injury. The management of these injuries continues to challenge reconstructive surgeons. Cryopreserved skin allografts have been successfully used to manage partial-thickness skin burns; however, dehydrated human amniotic/chorionic membrane (DHACM) represents novel technology. Dehydrated human amniotic/chorionic membrane outcomes have not been sufficiently studied to guide its use on genital burns. The objective of this study was to report on the outcomes of dehydrated amniotic membrane as a biologic skin dressing on genital burns injury compared with cryopreserved allografts.
Retrospective review of data collected from our institutional burn registry from 2012 to 2017. The study population included patients with partial-thickness genital burns admitted between 2012 and 2017 treated with either dehydrated human amniotic/chorionic membrane or cryopreserved allografts. Demographic characteristics and outcome measures were compared between the 2 groups.
Thirty patients with genital burns who received DHACM skin and cryopreserved allografts were included in the analysis. The mean age for the DHACM group was 27.6 years compared with 33.5 years for the cryopreserved group. The mean total body surface area was 3.8% in the DHACM group compared with 7.2% in the cryopreserved group (P = non-significant (ns)). The mean injury severity score was not significantly different between groups. Patients receiving cadaveric allografts had a higher number of skin substitute surgical reapplications as compared with the DHACM group (28% vs 0%, P ≤ 0.05). All patients who received DHACM skin substitutes healed by 2 weeks postoperative compared with 76% of patients who received cryopreserved skin allografts (P = 0.03, χ).
Dehydrated amniotic membrane skin substitutes are a safe alternative in the treatment of genital burns. Its use achieves comparable benefits with no major significant difference in terms of complication, supporting the safety of amniotic membrane to treat genital burns.
生殖器烧伤对患者有毁灭性影响,已被美国烧伤协会归类为重大烧伤损伤。这些损伤的处理仍然对重建外科医生构成挑战。冷冻保存的皮肤同种异体移植物已成功用于治疗部分厚度的皮肤烧伤;然而,脱水人羊膜/绒毛膜(DHACM)代表了一种新技术。尚未充分研究脱水人羊膜/绒毛膜的结果,无法指导其在生殖器烧伤中的应用。本研究的目的是报告与冷冻保存同种异体移植物相比,脱水羊膜作为生物皮肤敷料在生殖器烧伤损伤中的应用结果。
回顾性分析 2012 年至 2017 年从我们的机构烧伤登记处收集的数据。研究人群包括 2012 年至 2017 年间因部分厚度生殖器烧伤而入院并接受脱水人羊膜/绒毛膜或冷冻保存同种异体移植物治疗的患者。比较两组患者的人口统计学特征和结果测量。
纳入分析的 30 例生殖器烧伤患者接受 DHACM 皮肤和冷冻保存同种异体移植物治疗。DHACM 组的平均年龄为 27.6 岁,而冷冻保存组的平均年龄为 33.5 岁。DHACM 组的平均全身表面积为 3.8%,而冷冻保存组为 7.2%(P=非显著(ns))。两组之间的损伤严重程度评分无显著差异。与 DHACM 组相比,接受尸体同种异体移植物的患者皮肤替代物的再次应用次数更多(28%对 0%,P≤0.05)。所有接受 DHACM 皮肤替代物的患者在术后 2 周内愈合,而接受冷冻保存皮肤同种异体移植物的患者中 76%愈合(P=0.03,χ)。
脱水羊膜皮肤替代物是治疗生殖器烧伤的安全替代方法。其使用可达到类似的效果,在并发症方面没有显著差异,支持羊膜治疗生殖器烧伤的安全性。