Maruccia M, Magistri S, Elia R, Maggio G, Giudice G
Division of Plastic and Reconstructive Surgery, Department of Precision and Regenerative Medicine and Jonic Area, University of Bari, Bari, Italy.
Ann Burns Fire Disasters. 2024 Dec 31;37(4):305-311. eCollection 2024 Dec.
Deep intermediate burns of the hand are a challenge for both the functional and aesthetic result. In this study we compare the efficacy of early selective enzymatic escarolysis followed by the application of stromal vascular fraction (SVF) extracted from autologous adipose tissue on a dermal substitute scaffold (DS) versus reconstruction by partial thickness skin grafts (PTSG). We enrolled all patients admitted to our referral Burn Center from September 2020 to January 2022 with deep intermediate burns of the hands: clinical data were collected, then the first group of 4 patients were treated with PTSG surgical reconstruction, and the second group of 7 patients with DS+SVF. Subsequently, the morpho-functional and aesthetic outcome (with quickDASH and POSAS questionnaires), the healing time and the number of accesses in the operating room were evaluated. A total of 11 patients and 18 hands were treated in the period considered for the study. The mean TBSA was 22.5±15.2% in Group 1, 23.6±13.6% in Group 2; the mean age in Group 1 was 47.3±17.6 yo, in Group 2 51.4±16.3 yo. The mean follow up was 10±2.5 months. At six months qDASH and POSAS in Group 1 were: qDASH 53.4±2.5; OSAS 53.3±5.1; POSAS 51.3±4.3; in Group 2: qDASH 20.8±7.8; OSAS 19.7±8.1; POSAS 17.4±7.8. Group 1 had an average healing time of 75±15 days vs 20.4±9.3 days for Group 2, and 2.5±0.5vs1 accesses in the operating room. SVF combined with hyaluronic acid-based dermal substitute demonstrated a better morpho-functional and aesthetic outcome, and reduced patient healing time and accesses in the operating room compared to surgical partial thickness skin graft reconstruction in the treatment of intermediate-deep burns of the hand.
手部深度中度烧伤对功能和美观效果都是一项挑战。在本研究中，我们比较了早期选择性酶促焦痂溶解，随后在真皮替代支架（DS）上应用从自体脂肪组织提取的基质血管成分（SVF）与采用中厚皮片移植（PTSG）进行重建的疗效。我们纳入了2020年9月至2022年1月期间入住我们烧伤转诊中心的所有手部深度中度烧伤患者：收集临床数据，然后第一组4例患者接受PTSG手术重建，第二组7例患者接受DS+SVF治疗。随后，评估形态功能和美观结果（使用quickDASH和POSAS问卷）、愈合时间以及手术室的手术次数。在本研究考虑的时间段内，共治疗了11例患者和18只手。第一组的平均体表面积为22.5±15.2%，第二组为23.6±13.6%；第一组的平均年龄为47.3±17.6岁，第二组为51.4±16.3岁。平均随访时间为10±2.5个月。六个月时，第一组的qDASH和POSAS分别为：qDASH 53.4±2.5；OSAS 53.3±5.1；POSAS 51.3±4.3；第二组为：qDASH 20.8±7.8；OSAS 19.7±8.1；POSAS 17.4±7.8。第一组的平均愈合时间为75±15天，而第二组为20.4±9.3天，手术室手术次数分别为2.5±0.5次和1次。与手术中厚皮片移植重建相比，SVF联合基于透明质酸的真皮替代物在治疗手部中深度烧伤时表现出更好的形态功能和美观结果，并缩短了患者的愈合时间和减少了手术室手术次数。
