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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(1~3d)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。
Objective To observe the clinical effect of early excision of intact dermabrasion dermis graft (biological dressing and autologous skin) in the treatment of extensive burn patients with deep second degree wounds. Methods 68 cases of deep second degree burn wounds were treated with early (1-3 days) tangential excision and dermabrasion. The dermabrasion wound tissues were preserved with degenerative dermis. Most of the wounds were covered with biological dressings. For functional sites or deep II Degree (critical III degree) wounds were covered with autologous skin, and functional sites were implanted with thin or medium thick skin. 32 patients with functional grafts were followed up for 6 to 12 months. The overall healing and wound healing were observed. Results The wounds were healed in 2 to 3 weeks after operation in this group. Focal necrosis was found in 5 cases with functional skin graft and the remaining skin all survived. No case of sepsis and multiple organ dysfunction syndrome, the cure rate was 98.5%. Of the 32 patients who were followed up, 26 had good skin appearance, elasticity and functional recovery, and 6 had mild to moderate dysfunction. Conclusion Early deep excision of scleroderma and preservation of degenerative dermis in large-area deep second degree burns can effectively reduce the incidence of systemic infection, prevent or reduce the incidence of complications, improve the cure rate and shorten the wound healing time , Reduce scar formation, and early functional parts to be well repaired, thereby improving the quality of wound healing.