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目的探讨脱细胞同种异体真皮与自体刃厚皮复合移植修复深度烧伤功能部位创面的疗效。方法 2002年6月-2008年12月,收治30例烧伤及瘢痕整形患者共42个创面。男25例,女5例;年龄3～52岁,中位年龄31岁。烧伤24例35个创面,其中深Ⅱ度23个创面,Ⅲ度12个创面;病程3～45 d,平均24 d。瘢痕整形6例7个创面;病程9～21 d,平均16 d。42个创面分别位于颈部2个,手部4个,前臂及肘部8个,肩部3个,腘窝6个,膝部4个,小腿及足踝部15个。彻底清创、削痂及切除瘢痕后,创面范围为10 cm×10 cm～30 cm×20 cm。采用一步法将脱细胞同种异体真皮与自体刃厚皮复合移植修复创面。结果术后27例39个(92.9%)创面复合皮移植完全成活;3例3个(7.1%)创面复合皮部分坏死,分别经换药和自体皮片移植术后愈合。患者均获随访,随访时间30～34个月,平均32个月。复合皮有轻度色素沉着,外观平整,质地柔软,弹性好,皮肤耐磨;复合皮无挛缩及瘢痕增生,功能部位活动正常。刃厚皮供皮区未见瘢痕增生。结论脱细胞同种异体真皮与自体刃厚皮复合移植修复功能部位深度烧伤及瘢痕整形创面,可获得良好外形及功能。
Objective To investigate the effect of acellular allograft dermal autografting combined with autografting on the repair of wounds with deep burn wounds. Methods From June 2002 to December 2008, a total of 42 wounds were treated in 30 patients with burns and scarring. 25 males and 5 females; aged 3 to 52 years old, the median age of 31 years. Burn 24 cases of 35 wounds, of which 23 deep Ⅱ wounds, Ⅲ degree 12 wounds; duration of 3 ~ 45 d, an average of 24 d. 6 cases of scar plastic surgery 7 wounds; duration of 9 ~ 21 d, an average of 16 d. 42 wounds were located in the neck 2, 4 hands, forearms and elbows 8, 3 shoulder, popliteal fossa 6, knee 4, leg and ankle 15. Thoroughly debridement, excision scars and scar removal, the wound range of 10 cm × 10 cm ~ 30 cm × 20 cm. A one-step method of acellular allograft dermis and autologous blade thick skin graft repair wound. Results Twenty-nine (92.9%) wounds combined with skin graft survived completely in 27 cases. Three of the three wounds (7.1%) were partially necrotic and were healed after dressing change and autologous skin grafting. All patients were followed up for 30-34 months with an average of 32 months. Complex skin with mild pigmentation, the appearance of flat, soft texture, good elasticity, skin wear; contracture without contracture and scar hyperplasia, functional parts of normal activity. No skin hyperplasia was found in the thick skin for donor. Conclusion Acellular allograft dermal autografting combined with autografting combined with thick skin grafts can repair deep functional burns and scar plastic wounds and achieve good appearance and function.