目的 探讨持续负压吸引(continuous negative pressure aspiration, VSD)联合人工真皮支架、刃厚头皮移植在改善大面积烧伤颈部瘢痕挛缩中的应用价值。方法 选择2013-6至2017-12武警特色医学中心烧伤整形科收治大面积烧伤后颈部瘢痕挛缩畸形且使用持续负压吸引联合人工真皮支架、刃厚头皮移植的患者42例作为观察组,随机抽取同期采用颈部瘢痕松解后直接移植中厚皮的36例患者作为对照组。结果 两组患者颈部瘢痕松解后均能达到满意效果;观察组创面愈合时间平均为(17.48±1.52) d,对照组创面愈合时间平均为(13.36±2.06) d,观察组创面愈合后颈部后仰下颌角与颈部纵轴角度平均为135°±3.24°,左右旋转角度平均达150°±4.34°,而对照组患者创面愈合后颈部后仰下颌角与颈部纵轴角度平均为133°±3.62°,左右旋转角度平均达147°±3.28°,两组治疗后患者颈部瘢痕挛缩畸形得以改善,颈部功能得以改善,两组比较差异无统计学意义(P＞0.05)。结论 持续负压吸引联合人工真皮支架、刃厚头皮移植在改善大面积烧伤颈部瘢痕挛缩方面具有良好的效果。
Abstract
Objective To explore the applicability of continuous negative pressure suction combined with artificial dermal scaffolds and scalp transplantation in the treatment of large-area burn scar contracture.Methods Between June 2013 and December 2017, 42 cases of cervical scar contracture deformity after large area burn were treated with continuous negative pressure suction combined with artificial dermal scaffolds and scalp transplantation (the observation group), while another 36 cases of direct transplant of the moderately thick skin after cervical scarring were randomly selected as the control group.Results The average healing time of the wounds in the observation group was (17.48±1.52) days, compared to (13.36±2.06) days in the control group. After wound healing, the average value of cervical retro-mandibular angles and cervical longitudinal axis in the observation group was (135±3.24)°,compared with (150±4.34) °and (133±3.62)°in the control group. Neck function was improved in both groups, the skin graft of the neck was good in color and elasticity, and scar contracture was inhibited. The function of the neck scar was improved by either treatment. No significant difference was observed between the observation group and the control group.Conclusions Continuous negative pressure suction combined with artificial dermal scaffolds and scalp transplantation can improve the scar contracture of large-area burns.
关键词
持续负压吸引 /
人工真皮支架 /
瘢痕挛缩畸形
Key words
continuous negative pressure suction /
artificial dermal scaffold /
scar contracture deformity
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参考文献
[1] 张庆富,周慧敏,王车江,等.密集式缝合固定法应用于颌颈部植皮术临床效果观察[J].中华烧伤杂志,2012,28(4):244-245.
[2] Kleinert K,Werner C,Mamisch-Saupe N, et al. Closed suction drainage with or without re-transfusion of filtered shed blood does not offer advantages in primary non-cemented total hip replacement using a direct anterior approach[J]. Arch Orthop Trauma Surg,2012,132(1):131-136.
[3] 童利伟,刘 真,罗富琼,等.持续封闭负压吸引治疗糖尿病足的疗效观察[J]. 西南军医, 2017, 19(6): 523-526.[4] 崔文波,魏小华.负压封闭引流与常规敷料加压包扎对游离皮片植皮疗效的对比[J].临床医学,2012,32(12):13-15,封4.
[5] Fleischmann W,Strecker W,Bombelli M,et al. Vacuumsealing as treatment of soft tissue damage in open fractures[J]. Unfallchirurg,1993,96(9):488-492.
[6] 郭淑女,黄少耿,谢卫勇.等.应用人工真皮支架修复甲床缺损 57 例临床体会[J].中国医疗美容,2016,6(7):29-31.
[7] Suzuki S,Kawai K,Ashoori F,et al.Long-term follow-up study of artificial dermis composed of outer silicone layer and inner collagen sponge[J]. Br J Plast Surg,2000,53(8):659-666.
[8] Matsuda K,Suziki S,Isshiki N,et al.Influence of glycosaminoglycans on the collagen sponge component of a bilayer artificial skin[J].Biomaterials,1990,11(5):351-355.
[9] Thornton J F,Rohrich R J. Dermal substitute (Integra) for open nasal wounds[J]. Plast Reconstr Surg,2005,116(2):677.
[10] Clayman M A,Clayman S M,Mozingo D W. The use of collagen-glycosaminoglycan copolymer (Integra) for the repair of hypertrophic scars and keloids[J]. J Burn Care Res,2006,27(3):404-409.
[11] Matsuda K,Suzuki S,Isshiki N,et al. Evaluation of a bilayer artificialskin capable of sustained release of an antibiotic[J]. Biomaterials,1992,13(2):119-122.
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