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用于治疗未切除的部分厚度火焰烧伤的冷冻保存尸体同种异体移植物:12例患者的临床经验

Cryopreserved cadaveric allografts for treatment of unexcised partial thickness flame burns: clinical experience with 12 patients.

作者信息

Eldad A, Din A, Weinberg A, Neuman A, Lipton H, Ben-Bassat H, Chaouat M, Wexler M R

机构信息

Burn Unit, Hadassah University Hospital, Jerusalem, Israel.

出版信息

Burns. 1997 Nov-Dec;23(7-8):608-14. doi: 10.1016/s0305-4179(97)00054-5.

Abstract

Partial thickness burns (PTB) usually heal within 3 weeks. Prevention of infection and desiccation of the wounds are crucial for optimal healing. Early tangential excision of the burn eschar and allografting prevent deepening of the burns, and are therefore advocated for treatment with the best functional and aesthetic results. For superficial partial thickness burns (SPTB) conservative use of topical antimicrobial agents with frequent dressing changes are implemented. We compared the conservative treatment for PTBs and SPTBs to grafting cryopreserved cadaveric allografts with no prior excision. Twelve patients with flame PTB areas were allografted after mechanical debridement without excision of the burn wounds. The allografts were cadaveric skin cryopreserved by programmed freezing and stored at -180 degrees C for 30-48 months. Matching burns for depth and area were treated with silver sulfadiazine (SSD) one to two times daily until healing or debridement and grafting were required. It was found that 80 per cent of the cryopreserved allografts adhered well and 76 per cent of the treated areas healed within 21 days, whereas only 40 per cent of the SSD-treated burns healed within 21 days. Partial thickness burns can be treated successfully with viable human allografts (cryopreserved cadaveric skin) with no prior surgical excision. The burn wounds heal well within 3 weeks. For deep partial thickness burns (DPTB) treatment with allografts has no advantage if they have not been previously excised.

摘要

浅度烧伤(PTB)通常在3周内愈合。预防伤口感染和干燥对于实现最佳愈合至关重要。早期对烧伤焦痂进行削痂和异体皮移植可防止烧伤加深,因此提倡采用这种方法以获得最佳的功能和美观效果。对于浅Ⅱ度烧伤(SPTB),采用局部抗菌药物保守治疗并频繁更换敷料。我们将PTB和SPTB的保守治疗与未预先切除的冷冻保存尸体异体皮移植进行了比较。12例火焰烧伤PTB患者在机械清创后进行了异体皮移植,未切除烧伤创面。异体皮为通过程序冷冻保存的尸体皮肤,保存在-180℃下30 - 48个月。选取深度和面积匹配的烧伤创面,每日用1 - 2次磺胺嘧啶银(SSD)治疗,直至愈合或需要清创和移植。结果发现,80%的冷冻异体皮粘附良好,76%的治疗区域在21天内愈合,而SSD治疗的烧伤创面只有40%在21天内愈合。浅度烧伤可以用有活力的人异体皮(冷冻保存的尸体皮肤)成功治疗,无需预先手术切除。烧伤创面在3周内愈合良好。对于深度浅Ⅱ度烧伤(DPTB),如果未预先切除,异体皮移植治疗并无优势。

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