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背景:以往治疗大面积深度烧伤患者,常采用带有表皮的正常头皮微粒+异体(异种)皮混合移植。由于患者自身皮源缺乏,手术次数多,创面暴露时间长,死亡率高。目的:观察自体微粒头皮与第2层微粒头皮混合移植治疗特重度烧伤患者的效果,并与常规微粒头皮移植进行对比。设计、时间及地点:观察对照实验,于2005-01/2008-01在唐山钢铁公司医院烧伤科、唐山工人医院烧伤科、山西省烧伤救治中心、唐山路北红十字医院、唐山二五五医院烧伤科及唐山市第三医院烧伤科完成。对象:选取特重烧伤患者102例,平均烧伤面积为体表总面积的(60.55±3.21)%,Ⅲ度烧伤面积为体表总面积的(51.74±2.98)%,手术面积为体表总面积的(52.19±5.44)%。方法:采用自身对照的方法,每例患者选取较为对称、创面性质相同的2处Ⅲ度烧伤切痂创面进行对照。实验组行带表皮的正常自体微粒头皮与缺表皮的第2层自体微粒头皮混合移植;对照组移植常规微粒头皮。自头部取下的皮片面积与受皮区面积之比均为1︰10~1︰15。主要观察指标:应用网格计数法统计头皮移植后第3,4,5周末两组的创面愈合率。结果:移植后第3,4,5周末两组创面愈合率基本相近(P均>0.05)。结论:自体微粒头皮与第2层微粒头皮混合移植是一种治疗特重度烧伤的有效方法,可使头部供皮增加2倍,缓解了特重度烧伤患者自体皮源匮乏的困难,与传统正常头皮微粒移植相比创面愈合率无明显差异。
Background: In the past, patients with large area deep burn often used mixed scalp + scleroderma with epidermis. Due to the lack of their own skin source, the number of operations, the wound exposed a long time, high mortality. OBJECTIVE: To observe the effect of mixed autograft scalp and layer 2 microparticle scalp in the treatment of patients with extra-severe burns and to compare with conventional scalp transplantation. DESIGN, TIME AND SETTING: The controlled trials were performed at the Department of Burn, Tangshan Iron and Steel Hospital, Department of Burn, Tangshan Workers Hospital, Shanxi Burn Center, Tangshan North Red Cross Hospital, Tangshan No. 25 Hospital from January 2005 to January 2008. Department of Burn and Tangshan Third Hospital Burn completed. PARTICIPANTS: Totally 102 patients with severe burn were selected. The average burn area was (60.55 ± 3.21)%, the third degree burn area was (51.74 ± 2.98)%, the total area of the body surface (52.19 ± 5.44)% of the total. Methods: The method of self-control, each patient selected more symmetrical, the same nature of the wound surface of the second degree Ⅲ burn burns control. In the experimental group, the normal autologous microscopic scalp with epidermis was mixed with the second-layer autologous microscopic scalp without epidermis. The control group was transplanted with conventional microscopic scalp. Skin area removed from the head and the skin area ratio of 1 ︰ 10 ~ 1 ︰ 15. MAIN OUTCOME MEASURES: The wound healing rate of the two groups at the 3rd, 4th, 5th week after scalp transplantation was calculated by the grid counting method. Results: The wound healing rates of the two groups were similar at the 3rd, 4th, 5th week after transplantation (all P> 0.05). Conclusion: The combination of autologous microscopic scalp and the second layer of scalp transplantation is an effective method for the treatment of extra-severe burns, which can increase the head skin supply by 2 times, relieve the difficulty of autologous skin scarcity in patients with severe burns, There was no significant difference in wound healing rate between scalp particle transplantation and wound healing.