Chew Khong-Yik, Tan Gerald Yz, Tan Bien-Keem
Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore.
Department of Plastic, Reconstructive, & Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
JPRAS Open. 2025 May 20;45:480-490. doi: 10.1016/j.jpra.2025.05.006. eCollection 2025 Sep.
Burn injuries affecting specialised areas such as the face and hands require durable skin coverage and complete graft "take" to prevent scarring and functional impairment. Failure to achieve these outcomes can lead to long-term complications. This presentation aims to describe an approach of delayed autografting in these regions, following a "trial of allograft" to optimise wound bed preparation. We hypothesize that a trial of allograft prior to autografting improves graft take, and hence aesthetic and functional outcomes in specialised burn areas.
Four patients with burns involving the hands ( = 3) and face ( = 2) were treated using allografts. The patients presented with TBSA burns of 60 %, 60 %, 55 %, and 2 %, respectively. In three cases, the primary indication for this approach was to prioritise life-saving coverage through the use of micrografts, while temporarily allografting the hands for three weeks. Skin exchange with sheet autografts was performed after re-excision of any non-viable areas, except in one patient who succumbed to pneumonia due to inhalation injuries. For facial burns, serial tangential excision was performed followed by allograft application to assess the viability of the wound bed, as indicated by their take.
Initial allograft take was 80 %. After re-preparation of non-take areas, autograft adherence reached 100 %. One patient expired before skin exchange could be performed.Two patients who successfully underwent skin exchange regained full ROM and independent ADLs. The facial burn patient achieved minimal scarring and full mimetic function, with preserved cosmetic subunits.
Delayed autografting of specialised areas facilitated optimal wound bed preparation, ensuring a 100 % take of the autograft.
影响面部和手部等特殊部位的烧伤需要持久的皮肤覆盖和移植皮片完全“存活”，以防止瘢痕形成和功能障碍。未能实现这些结果可能导致长期并发症。本报告旨在描述在这些区域采用“同种异体移植试验”后进行延迟自体移植的方法，以优化创面床准备。我们假设在自体移植前进行同种异体移植试验可提高移植皮片的存活率，从而改善特殊烧伤部位的美观和功能结果。
4例手部（n = 3）和面部（n = 2）烧伤患者接受了同种异体移植治疗。患者的总体表面积烧伤分别为60%、60%、55%和2%。在3例病例中，该方法的主要指征是通过使用微小皮片优先进行挽救生命的覆盖，同时对手部进行为期3周的临时同种异体移植。在切除任何无活力区域后，用自体皮片进行皮肤置换，除1例因吸入性损伤死于肺炎的患者外。对于面部烧伤，进行连续削痂，然后应用同种异体移植以评估创面床的活力，以其存活情况为指标。
最初同种异体移植皮片的存活率为80%。在对未存活区域重新准备后，自体移植皮片的黏附率达到100%。1例患者在进行皮肤置换前死亡。2例成功进行皮肤置换的患者恢复了完全的关节活动度和独立的日常生活活动能力。面部烧伤患者瘢痕形成最小，面部表情功能完全恢复，美容亚单位得以保留。
特殊部位的延迟自体移植有助于优化创面床准备，确保自体移植皮片100%存活。
