早期削痂保留变性真皮治疗大面积深Ⅱ度烧伤疗效观察.docVIP

早期削痂保留变性真皮治疗大面积深Ⅱ度烧伤疗效观察【摘要】 目的 观察早期削痂保留变性真皮移植有效覆盖物(生物敷料、自体皮)治疗以深Ⅱ度创面为主的大面积烧伤患者的临床效果。方法 对68例大面积深Ⅱ度烧伤创面行早期(1~3 d)削痂术，削痂后创面保留变性的真皮组织，大部分创面以生物敷料覆盖，对于功能部位或接近Ⅲ度的深Ⅱ度(临界Ⅲ度)创面，以自体皮覆盖，功能部位植入薄中厚或中厚皮，并对32例功能部位植皮患者随访6~12个月，观察患者总体治愈情况及创面愈合效果。结果 本组患者术后2~3周创面愈合，功能部位植入皮片有5例出现局灶性坏死，其余皮片全部存活。无一例出现脓毒症及多器官功能障碍综合征，治愈率为98．5%。随访32例患者中，26例其皮肤外观、弹性及功能恢复良好，6例有轻、中度的功能障碍。结论 大面积深Ⅱ度烧伤采用早期削痂并保留变性真皮，同时移植有效覆盖物，既可有效减少全身感染的发生率，预防或减少并发症的发生，提高治愈率，又可缩短创面愈合时间，减轻瘢痕形成，且功能部位早期得以良好修复，从而提高创面愈合质量。 【关键词】烧伤；削痂；变性真皮；生物敷料；皮肤移植 Clinical observations of tangential excision with the preservation of denatured dermis on the deep partial thickness burn wounds in early period JIA Jun,YANG Tao,SONG Guo-dong,et al.Department of Burns,Jinan Central Hospital attached to Shandong University,Shangdong 250013,China 【Abstract】 Objective To evaluate the effect of utility covering graft on the deep partial thickness burn wounds with the preservation of denatured dermis after tangential excision in burn patients.Methods Tangential excision,with the preservation of denatured dermis,was performed in 68 burn patients within 3 post burn days.Most of the raw surface was covered with biological dressing,and middle-thickness auto skin was grafted in function position and near full thickness burn wound.32 patients were followed up from 6 to 12 months and the total healing condition of patients and healing effect were observed.Results The wound concreted within 2~3 weeks post operating day.Except that focal necrosis was encountered in 5 patients of the grafts in function position,the skin graft survived well.The healing rate was 98．5 %.The grafted skin in 26 patients was excellent in the appearance,elasticity and function after 6 to 12 months of follow up,at the same time,light or medium functional disturbance was discovered in the other 6 patients.Conclusion Themethod of tangential excision in patients with the deep partial thickness burn wounds and utility covering grafting,with the preservation of denatured dermis,not only ca