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目的探讨脱细胞异体真皮联合头刃厚皮修复儿童瘢痕创面的临床效果。方法 52例外伤及烧伤后瘢痕,根据瘢痕切除后创面封闭术式分为复合植皮组和自体植皮组各26例,一次性切除瘢痕后,复合植皮组采用脱细胞异体真皮联合头刃厚皮移植修复创面,自体植皮组采用自体刃厚皮片或薄中厚皮片移植修复创面。比较2组植皮成活率和植皮后创面完全愈合时间,随访10个月,观察创面移植区域的色泽、质地、皮下丰满度、瘢痕增生情况及对关节功能的影响等。结果复合植皮组创面植皮成活率(92.31%)、创面愈合时间[(12.62±3.18)d]与自体植皮组[96.15%、(11.90±2.61)d]比较差异均无统计学意义(P>0.05);复合植皮组植皮区丰满,瘢痕增生轻,色泽、质地优于自体植皮组(P<0.05);复合植皮组关节功能受影响5例,自体植皮组关节功能受影响10例,差异有统计学意义(P<0.05);复合植皮组头皮供皮区均无瘢痕增生,自体植皮组供皮区色素改变16例,瘢痕形成10例,其中2种情况均发生者8例,供皮区瘙痒16例,供皮区反复破溃3例,影响睡眠5例。结论脱细胞异体真皮联合头刃厚皮修复儿童瘢痕丰满度高、瘢痕增生轻,功能恢复好,供皮区损伤小。
Objective To investigate the clinical effect of acellular allogenic dermal combined with head-edge thick skin in repairing scar of children. Methods Fifty-two traumatic and post-burn scars were divided into two groups according to wound closure surgery: 26 cases of compound grafting group and autologous skin grafting group. After a one-time scar removal, the allograft skin graft combined with allograft Repair wounds, autologous skin grafting group with self-edge thick skin graft or thin skin graft repair wound. The survival rate of skin grafts were compared between the two groups. The wound healing time was 10 months. The color, texture, subcutaneous fullness, scar hyperplasia and the effect on joint function were observed. Results The skin grafting survival rate (92.31%) and wound healing time (12.62 ± 3.18) days in the composite skin grafting group were not significantly different from those in the autologous skin grafting group [96.15%, (11.90 ± 2.61) d] (P> 0.05 ). The skin graft area in the composite skin grafting group was full with scarring hyperplasia, better color and texture than the autologous skin grafting group (P <0.05). The function of the joint in the compound grafting group was affected in 5 cases and in the autologous skin grafting group, the joint function was affected in 10 cases (P <0.05). No skin hyperplasia was found in the donor skin of the scalp skin in the autologous skin grafting group. There were 16 cases of skin graft change and 10 cases of scar formation in the autologous skin grafting group, including 8 cases in 2 cases and pruritus in the donor area 16 cases, for the skin area repeatedly rupture in 3 cases, affecting sleep in 5 cases. Conclusion Acellular dermal allograft combined with scalp skin repair has the advantages of high fullness of scar, less hyperplasia of scar, better function recovery and less damage to donor area.