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[人工真皮联合自体皮修复小儿电烧伤后手指骨和/或肌腱外露创面的效果]

[Effects of artificial dermis combined with autologous skin in repairing the wounds with exposed bone and/or tendon in fingers of children after electric burns].

作者信息

Yang H N, Liang Y, Han D W, Liu L, Xie J F, Tian S M, Xia C D, Wei Y

机构信息

Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China.

出版信息

Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi. 2023 Dec 20;39(12):1180-1184. doi: 10.3760/cma.j.cn501225-20231101-00168.

Abstract

To explore the effects of artificial dermis combined with autologous skin in repairing the wounds with exposed bone and/or tendon in fingers of children after electric burns. A retrospective observational study was conducted. From January 2017 to December 2022, 14 children with bone and/or tendon exposed wounds in fingers after electric burns who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, including 9 males and 5 females, aged 2 to 11 years. A total of 38 fingers were affected, with 1 wound per finger. After debridement, artificial dermal coverage combined with vacuum sealing drainage was performed in all the wounds in the first stage, with wound area of 2.0 cm×1.0 cm-4.5 cm×2.5 cm after debridement. The second stage surgery was performed to close the wound with autologous thin intermediate thickness skin graft. Then the children were told to perform functional rehabilitation exercise as early as possible. The survival of autologous skin graft was observed at the 7 day after the second stage surgery. The wound healing time was recorded. After 12 months of follow-up, the Vancouver scar scale was used to evaluate the scar hyperplasia at the skin grafting site of the affected finger; the total action mobility (TAM) of the affected finger joint was measured for evaluating the functional recovery of the affected finger; a self-made efficacy satisfaction rating table was used to investigate the parents' satisfaction with the curative effect of the children. At the 7 day after the second stage surgery, all the children had good survival of autologous skin grafts. The wound healing time was (24.1±2.7) d. After 12 months of follow-up, the scar score at the skin grafting site of the affected finger was 5.2±2.4; the TAM of the affected finger joint was (177±40)°; the functional assessment was good in 12 fingers, medium in 23 fingers, and poor in 3 fingers; the parents' satisfaction with the curative effect of the children in the survey was very satisfied in 10 cases, satisfied in 3 cases, and dissatisfied in 1 case. The combination of artificial dermis and autologous thin intermediate thickness skin graft is an alternative surgical method that can effectively repair the bone and/or tendon exposed wounds in fingers of children after electric burns. After wound healing, the scars are slight, the finger function is well recovered, and the parents of the children are highly satisfied with the curative effect of the children, which is worthy of clinical promotion.

摘要

探讨人工真皮联合自体皮修复小儿电烧伤后手指骨和/或肌腱外露创面的效果。进行一项回顾性观察研究。2017年1月至2022年12月,郑州人民医院收治符合纳入标准的小儿电烧伤后手指骨和/或肌腱外露创面患者14例,其中男9例,女5例,年龄2~11岁。共累及38指,每指1处创面。清创后,一期对所有创面行人工真皮覆盖联合封闭负压引流,清创后创面面积为2.0 cm×1.0 cm - 4.5 cm×2.5 cm。二期手术采用自体薄中厚皮片封闭创面。然后告知患儿尽早进行功能康复锻炼。观察二期手术后7天自体皮片存活情况。记录创面愈合时间。随访12个月后,采用温哥华瘢痕量表评估患指植皮部位瘢痕增生情况;测量患指关节总主动活动度(TAM)以评估患指功能恢复情况;采用自制疗效满意度评分表调查患儿家长对患儿治疗效果的满意度。二期手术后7天,所有患儿自体皮片存活良好。创面愈合时间为(24.1±2.7)天。随访12个月后,患指植皮部位瘢痕评分为5.2±2.4;患指关节TAM为(177±40)°;功能评估优12指,良23指,差3指;调查中患儿家长对患儿治疗效果非常满意10例,满意3例,不满意1例。人工真皮联合自体薄中厚皮片移植是一种可有效修复小儿电烧伤后手指骨和/或肌腱外露创面的手术方法。创面愈合后瘢痕轻微,手指功能恢复良好,患儿家长对患儿治疗效果满意度高,值得临床推广。

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