Ji Chao, Wang Yuxiang, Chen Tiansheng, Hu Xiaoyan, Fang He, Yan Zhenzhen, Ma Yicheng, Fang Xiaowan, Li Linhui, Xu Dayuan, Ji Shizhao, Luo Pengfei, Zheng Yongjun, Xiao Shichu
Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, China.
Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, China.
Burns. 2025 Mar;51(2):107356. doi: 10.1016/j.burns.2024.107356. Epub 2024 Dec 16.
The wound repair process for extensively deep burn patients is a recurring and highly challenging endeavor. A prolonged healing time beyond 3 weeks after injury often leads to compromised healing outcomes. The limited availability of autologous skin grafts remains the primary obstacle in achieving timely wound repair. This study aimed to investigate an approach that minimizes the reliance on autologous skin grafts for repairing residual wounds in severe burn patients.
This was a retrospective review of 74 burn patients with large residual wounds in the middle- and late-stages of treatment who were admitted to the Burn Center of the First Affiliated Hospital of Naval Medical University between 2012 and 2022. Mixed grafting of small auto- and cryopreserved allo-skin was used in 32 patients with an expansion ratio of 1:9-16. Routine microskin grafting was applied in 17 cases with an expansion ratio of 1:10-15. Meek grafting was employed in 25 patients with an expansion ratio of 1:4-6. The main outcomes of this study were the wound healing rate and scar formation.
The wound healing rate in the mixed grafting group was significantly greater than that in the microskin and Meek grafting groups (89 ± 5.8 % vs. 66.5 ± 6.9 % and 75.4 ± 5.1 %, respectively; P < 0.001). Multiple linear regression analysis showed that under the same conditions, the wound healing rate of microskin grafting and Meek grafting decreased by 24.6 % and 16.8 % compared with mixed grafting respectively. Follow-up studies of 43 of total 74 burn patients over 1-2 years revealed that the mean VSS scores for pigmentation, pliability, scar height, and vascularity in the mixed grafting group (n = 23) were significantly lower (total score 4.23 ± 2.17) than those in the microskin grafting group (n = 12; 6.02 ± 2.73, P = 0.03), and not significantly different from those in the Meek grafting group (n = 18; 4.37 ± 2.13, P = 0.74).
Mixed grafting of small auto- and allo-skin minimizes the reliance on limited autologous skin resources while achieving superior healing rates and lower scar formation for repairing deep burn wounds. Compared with the microskin and Meek grafting methods, the mixed grafting approach significantly enhances wound healing rates and outcomes in patients with extensive deep burns. Our findings suggest that mixed grafting is a viable and effective strategy for improving wound repair and functional outcomes in severely burned patients.
广泛深度烧伤患者的伤口修复过程反复且极具挑战性。受伤3周后愈合时间延长往往会导致愈合效果不佳。自体皮肤移植的可用性有限仍然是及时进行伤口修复的主要障碍。本研究旨在探索一种方法，尽量减少严重烧伤患者修复残余伤口时对自体皮肤移植的依赖。
这是一项对2012年至2022年间海军军医大学第一附属医院烧伤中心收治的74例处于治疗中晚期且有大面积残余伤口的烧伤患者的回顾性研究。32例患者采用小面积自体皮与冷冻保存异体皮混合移植，扩展比例为1:9 - 16。17例患者采用常规微粒皮移植，扩展比例为1:10 - 15。25例患者采用Meek植皮法，扩展比例为1:4 - 6。本研究的主要结果是伤口愈合率和瘢痕形成情况。
混合移植组的伤口愈合率显著高于微粒皮移植组和Meek植皮组（分别为89±5.8% vs. 66.5±6.9%和75.4±5.1%；P<0.001）。多元线性回归分析表明，在相同条件下，微粒皮移植和Meek植皮的伤口愈合率与混合移植相比分别降低了24.6%和16.8%。对74例烧伤患者中的43例进行1 - 2年的随访研究发现，混合移植组（n = 23）色素沉着、柔韧性、瘢痕高度和血管化的平均温哥华瘢痕量表（VSS）评分显著低于微粒皮移植组（n = 12；6.02±2.73，P = 0.03），与Meek植皮组（n = 18；4.37±2.13，P = 0.74）无显著差异。
小面积自体皮与异体皮混合移植在修复深度烧伤创面时，在尽量减少对有限自体皮肤资源依赖的同时，实现了更高的愈合率和更低的瘢痕形成。与微粒皮移植和Meek植皮方法相比，混合移植方法显著提高了广泛深度烧伤患者的伤口愈合率和治疗效果。我们的研究结果表明，混合移植是改善严重烧伤患者伤口修复和功能结局的一种可行且有效的策略。
