老年中厚皮供皮区回植自体刃厚皮疗效观察

王振君; 潘孙峰; 方高丰; 刘良; 朱敏达

doi:10.16766/j.cnki.issn.1674-4152.002451

老年中厚皮供皮区回植自体刃厚皮疗效观察

doi: 10.16766/j.cnki.issn.1674-4152.002451

浙江省中医药大学附属嘉兴市中医院烧伤整形科，浙江嘉兴 314001

基金项目:

浙江省医药卫生科技计划项目 2020PY075

嘉兴市科技局项目 2019AY32017

详细信息

通讯作者:
王振君，E-mail: wzj63999@163.com

中图分类号: R622.1
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出版历程
- 收稿日期: 2021-04-19
- 网络出版日期: 2022-09-05

Observation on the curative effect of replantation of autologous thick skin in the donor area of elderly medium-thickness skin

Department of Burn Orthopaedics, Jiaxing Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Chinese Medicine, Jiaxing, Zhejiang 314001, China

摘要

摘要: 目的观察老年患者自体刃厚皮回植中厚皮供皮区的治疗效果，探寻一种新的治疗方法。方法选取2019年3月—2020年6月嘉兴市中医院烧伤整形科就诊并符合入组条件的老年深度烧伤、瘢痕挛缩患者50例，采用随机数字表法分为治疗组和对照组，每组各25例。2组患者均选取大腿前外侧为供皮区，切取中厚皮片0.3~0.4 mm，修复烧伤、功能部位及瘢痕整形等创面。治疗组从中厚皮片供皮区旁切取刃厚皮片0.12~0.15 mm，皮片打孔移植于中厚皮片供皮区；对照组供皮区外敷凡士林纱布后加压包扎；比较2组患者中厚皮片供皮区愈合时间、温哥华瘢痕量表评分、瘙痒评分情况。结果术后第7天治疗组中厚皮片供皮区移植皮片全部成活, 中厚皮片供皮区愈合时间为9.0(8.0, 12.0) d, 显著短于对照组的21.0(20.5, 24.5) d, 差异有统计学意义(P < 0.05)。术后3个月治疗组供皮区温哥华瘢痕量表评分[3.0(2.0, 3.5)分]低于对照组[10.0(9.0, 11.0)分], 差异有统计学意义(P < 0.05);瘙痒评分[1.0(1.0, 2.0) 分]低于对照组[6.0(5.0, 7.0)分], 差异有统计学意义(P < 0.05)。术后半年治疗组供皮区温哥华瘢痕量表评分[1.0(0.5, 1.5)分]低于对照组[6.0(4.0, 8.5)分], 差异有统计学意义(P < 0.05);瘙痒评分[1.0(1.0, 1.0)分]低于对照组[2.0(1.0, 2.5)分], 差异有统计学意义(P < 0.05)。结论采用自体刃厚皮移植老年中厚皮片供皮区可明显缩短创面愈合时间，减轻瘢痕增生程度，具有较好的临床效果。
- 老年人 /
- 中厚皮供皮区 /
- 自体刃厚皮 /
- 回植 /
- 瘢痕
Abstract: Objective To observe the therapeutic effect of autologous thick skin replantation in the donor area of medium-thickness skin in elderly patients and explore a new therapeutic method. Methods A total of 50 elderly patients with deep burns and scar contracture who were admitted to the Department of Burns and Orthopaedics of Jiaxing Hospital of Traditional Chinese Medicine from March 2019 to June 2020 and who met the inclusion criteria were selected and divided into the treatment group and the control group by random number table method, with 25 patients in each group. The anterolateral thigh was selected as the donor area in both groups, and medium-thickness skin slices (0.3-0.4 mm) were cut to repair burns, functional parts, scars and other wounds. In the treatment group, blade thick skin slices (0.12-0.15 mm) were cut beside the donor area of the medium-thickness skin slices, and the slices were perforated and transplanted into the donor area of the medium-thickness skin slices. The donor area of the control group was covered with Vaseline gauze and then bandaged under pressure. The healing time, Vancouver Scar Scale score and pruritus score of medium-thickness skin donor site were compared between the two groups. Results On the 7th day after operation, all the donor grafts in the treatment group survived, and the healing time of donor grafts in the treatment group [9.0(8.0, 12.0) d] was significantly shorter than that in the control group [21.0(20.5, 24.5) d], with statistical significance (P < 0.05). Three months after surgery, the Vancouver Scar Scale score in the treatment group [3.0(2.0, 3.5) points] was lower than that in the control group [10.0(9.0, 11.0) points], the difference was statistically significant (P < 0.05), and the pruritus score [1.0(1.0, 2.0) points] was lower than that in the control group [6.0(5.0, 7.0) points], and the difference was statistically significant all (P < 0.05). Six months after surgery, the Vancouver scar scale score in the donor area of the treatment group [1.0(0.5, 1.5) points] was lower than that of the control group [6.0(4.0, 8.5) points], the difference was statistically significant (P < 0.05), and the pruri- tus score [1.0(1.0, 1.0) points] was lower than that of the control group [2.0(1.0, 2.5) points], the difference was statistically significant (P < 0.05). Conclusion The use of autologous blade thick skin grafting medium-thickness skin donor area can significantly shorten the wound healing time, reduce the degree of scar hyperplasia and has a good clinical effect.
- The aged /
- Medium-thickness skin donor area /
- Autologous blade thick skin /
- Replantation /
- Scar

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图 1 治疗组典型病例术中创面

注：左大腿前外侧中厚皮供皮区移植刃厚皮片创面及刃厚皮供皮区创面。

Figure 1. Typical intraoperative woundsin treatment group

下载: 全尺寸图片幻灯片

图 2 治疗组典型病例术后3个月随访

注：左大腿前外侧供皮区边缘轻度瘢痕形成，其余无瘢痕增生，刃厚皮供皮区色素改变。

Figure 2. Typical cases in treatment group were followed up for 3 months after operation

下载: 全尺寸图片幻灯片

图 3 治疗组典型病例术后半年随访

注：左大腿前外侧中厚皮片供皮区、刃厚皮片供皮区轻度色素沉着。

Figure 3. Typical cases in treatment group were followed up for 6 months after operation

下载: 全尺寸图片幻灯片

图 4 对照组典型病例术中创面

注：左大腿前外侧中厚皮供皮区继发创面。

Figure 4. Intraoperative wounds of typical cases in the control group

下载: 全尺寸图片幻灯片

图 5 对照组典型病例术后3个月随访

注：左大腿前外侧供皮区瘢痕增生明显，伴色素改变。

Figure 5. Typical cases in control group were followed up for 3 months after operation

下载: 全尺寸图片幻灯片

图 6 对照组典型病例术后半年随访

注：左大腿前外侧供皮区色素消退，仍有瘢痕增生。

Figure 6. Typical cases in the control group were followed up for 6 months after operation

下载: 全尺寸图片幻灯片

表 1 2组老年深度烧伤、瘢痕挛缩患者一般情况比较

Table 1. Comparison of general conditions between two groups of elderly patients with deep burn and cicatricial contracture

组别	例数	性别(男/女，例)	年龄(x±s，岁)	植皮区面积(x±s，cm²)	中厚皮供皮区面积(x±s，cm²)	刃厚皮取皮面积(x±s，cm²)
治疗组	25	15/10	70.52±6.86	72.08±30.94	69.64±30.46	67.80±30.03
对照组	25	18/7	70.68±6.91	69.56±30.13	66.84±28.51
统计量		0.347^a	-0.082^b	0.292^b	0.336^b
P值		0.556	0.935	0.772	0.739
注：^a为χ²值，^b为t值。

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表 2 2组老年深度烧伤、瘢痕挛缩患者术后3个月mVSS评分比较[M(P₂₅, P₇₅), 分]

Table 2. Comparison of mVSS scores between two groups of elderly patients with deep burn and cicatricial contracture at 3 months after operation[M(P₂₅, P₇₅), points]

组别	例数	色泽	血管分布	皮肤厚度	皮肤柔软度	瘢痕总评分
治疗组	25	1.0(1.0, 1.0)	1.0(0, 1.0)	1.0(0, 1.0)	1.0(0, 1.0)	3.0(2.0, 3.5)
对照组	25	2.0(2.0, 3.0)	3.0(2.0, 3.0)	3.0(2.0, 3.0)	2.0(2.0, 3.0)	10.0(9.0, 11.0)
Z值		-5.955	-5.850	-5.873	-5.742	-6.068
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

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表 3 2组老年深度烧伤、瘢痕挛缩患者术后半年mVSS评分比较[M(P₂₅, P₇₅), 分]

Table 3. Comparison of mVSS scores between two groups of elderly patients with deep burn and cicatricial contracture six months after operation[M(P₂₅, P₇₅), points]

组别	例数	色泽	血管分布	皮肤厚度	皮肤柔软度	瘢痕总评分
治疗组	25	0(0, 1.0)	0(0, 0)	0(0, 1.0)	0(0, 1.0)	1.0(0.5, 1.5)
对照组	25	1.0(1.0, 1.0)	2.0(1.0, 2.0)	1.0(1.0, 2.0)	2.0(1.0, 2.5)	6.0(4.0, 8.5)
Z值		-4.090	-5.602	-5.385	-5.149	-5.734
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

下载: 导出CSV

参考文献(20)

[1]	江政英, 闵定宏, 郭光华. 老年烧伤创面处理的研究进展[J]. 中华损伤与修复杂志(电子版), 2017, 12(6): 467-469. doi: 10.3877/cma.j.issn.1673-9450.2017.06.013 JIANG Z Y, MIN D H, GUO G H. Research progress in wound treatment of burns in the elderly[J]. Chinese Journal of Injury Repair and Wound Healing, 2017, 12(6): 467-469. doi: 10.3877/cma.j.issn.1673-9450.2017.06.013
[2]	黄跃生, 任家顺, 钱桂生, 等. 实用烧伤治疗学[M]. 郑州: 郑州大学出版社, 2013: 390-391. HUANG Y S, REN J S, QIAN G S, et al. Practical burn therapy[M]. Zhengzhou: Zhengzhou University Press, 2013: 390-391.
[3]	沈小鹏, 李东. 瘢痕防治及其研究进展[J]. 中华临床医师杂志(电子版), 2019, 13(6): 463-467. doi: 10.3877/cma.j.issn.1674-0785.2019.06.012 SHEN X P, LI D. Progress in scar prevention and treatment[J]. Chinese Journal of Clinicians(Electronic Edition), 2019, 13(6): 463-467. doi: 10.3877/cma.j.issn.1674-0785.2019.06.012
[4]	黄涛, 何升东, 李先慧, 等. 326例烧伤患者瘢痕瘙痒情况的总结分析[J]. 西南国防医药, 2019, 29(7): 749-751. doi: 10.3969/j.issn.1004-0188.2019.07.009 HUANG T, HE S D, LI X H, et al. Summary and analysis of scar pruritus in 326 burn patients[J]. Summary and analysis of scar pruritus in 326 burn patients, 2019, 29(7): 749-751. doi: 10.3969/j.issn.1004-0188.2019.07.009
[5]	刘继松, 宋德恒, 赵刚宏, 等. 新型生物敷料Ⅱ型在二度烧伤创面中的应用[J]. 中华全科医学, 2018, 16(5): 740-743. doi: 10.16766/j.cnki.issn.1674-4152.000201 LIU J S, SONG D H, ZHANG G H, et al. Application of new biological dressing type Ⅱ in the second degree burn wounds[J]. Chinese general practice, 2018, 16(5): 740-743. doi: 10.16766/j.cnki.issn.1674-4152.000201
[6]	吕鑫, 李磊, 张正文, 等. 促进中厚皮片移植供皮区修复的研究进展[J]. 中国美容医学, 2017, 26(1): 133-136. https://www.cnki.com.cn/Article/CJFDTOTAL-MRYX201701048.htm LYU X, LI L, ZHANG Z W, et al. Advances in research restoration of donor skin in intermediate thickness skin graft[J]. Chinese Journal of Aesthetic Medicine, 2017, 26(1): 133-136. https://www.cnki.com.cn/Article/CJFDTOTAL-MRYX201701048.htm
[7]	苏洋, 李欣, 邓程霖, 等. 老年综合评估工具的研究进展[J]. 中国老年学杂志, 2019, 39(5): 1270-1273. doi: 10.3969/j.issn.1005-9202.2019.05.076 SU Y, LI X, DENG C L, et al. Research progress of comprehensive geriatric assessment tool[J]. Chinese Journal of Gerontology, 2019, 39(5): 1270-1273. doi: 10.3969/j.issn.1005-9202.2019.05.076
[8]	中华医学会老年医学分会. 老年患者衰弱评估与干预中国专家共识[J]. 中华老年医学杂志, 2017, 36(3): 251-256. Geriatric Society of Chinese Medical Association. Chinese experts consensus on assessment and intervention for elderly patients with frailty[J]. Chinese experts consensus on assessment and intervention for elderly patients with frailty, 2017, 36(3): 251-256.
[9]	王丽, 丁晓红, 于水. 供皮区创面应用两种不同敷料的疗效对比[J]. 临床骨科杂志, 2017, 20(2): 248-250. doi: 10.3969/j.issn.1008-0287.2017.02.048 WANG L, DING X H, YU S. Comparison effect of two kinds of wound dressing for skin donor sites[J]. Journal of Clinical Orthopaedics, 2017, 20(2): 248-250. doi: 10.3969/j.issn.1008-0287.2017.02.048
[10]	王书军, 温从吉, 于海洲. 皮耐克在大面积烧伤患者关节部位瘢痕挛缩修复中的应用[J]. 中国美容医学, 2017, 26(11): 19-21. https://www.cnki.com.cn/Article/CJFDTOTAL-MRYX201711009.htm WANG S J, WEN C J, YU H Z. Application of PELNAC in the treatment of joints'scar plastic reconstruction[J]. Chinese Journal of Aesthetic Medicine, 2017, 26(11): 19-21. https://www.cnki.com.cn/Article/CJFDTOTAL-MRYX201711009.htm
[11]	黄耿坡. 探究自体头皮移植修复烧伤创面的效果[J]. 中国现代药物应用, 2019, 13(11): 82-83. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWYY201911044.htm HUANG G P. To explore the effect of autologous scalp transplantation in repairing burn wounds[J]. Chinese Journal of Modern Drug Application, 2019, 13(11): 82-83. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWYY201911044.htm
[12]	孙星辰. 异种脱细胞真皮基质敷料与凡士林油纱在中厚皮片供区术后愈合的临床研究[D]. 蚌埠: 蚌埠医学院, 2018. SUN X C. Clinical study on postoperative healing of allogeneic acellular dermal matrix dressing and vaseline gauze in medium thickness skin patch donor site[D]. Bengbu: Bengbu Medical College, 2018.
[13]	文科, 马燕, 刘漪沦, 等. 聚酰胺纱布敷料在急慢性创面的临床应用[J]. 中华全科医学, 2018, 16(3): 380-382. doi: 10.16766/j.cnki.issn.1674-4152.000105 WEN K, MA Y, LIU Y L. Clinical application of polyamide gauze dressing in acute and chronic wounds[J]. Chinese general practice, 2018, 16(3): 380-382. doi: 10.16766/j.cnki.issn.1674-4152.000105
[14]	赵刚宏, 李勇, 刘继松, 等. 脱细胞真皮基质敷料在烧伤创面治疗中的应用进展[J]. 中华损伤与修复杂志(电子版), 2019, 14(3): 228-230. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHSX201903013.htm ZHAO G H, LI Y, LIU J S, et al. Progress in the application of acellular dermal matrix dressing in the treatment of burn wounds[J]. Chinese Journal of Injury Repair and Wound Healing, 2019, 14(3): 228-230. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHSX201903013.htm
[15]	沈小鹏, 李东. 瘢痕防治及其研究进展[J]. 中华临床医师杂志(电子版), 2019, 13(6): 463-467. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLYD201906012.htm SHEN X P, LI D. Progress in scar prevention and treatment[J]. Chinese Journal of Clinicians(Electronic Edition), 2019, 13(6): 463-467. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLYD201906012.htm
[16]	林时秀, 郭冰玉, 回蔷, 等. 刺五加皂苷E对人增生性瘢痕成纤维细胞生长的影响及其机制[J]. 中华烧伤杂志, 2021, 37(3): 279-281. LIN S X, GUO Y B, HUI Q, et al. Effects and mechanism of eleutheroside E on the growth of human hypertrophic scar fibroblasts[J]. Chinese Journal of Burns, 2021, 37(3): 279-281.
[17]	林宇建, 韩兵, 麦钰仪, 等. 深度创伤后瘢痕发生发展机制及干细胞来源的外泌体治疗研究进展[J]. 广东药科大学学报, 2021, 37(1): 142-147. https://www.cnki.com.cn/Article/CJFDTOTAL-GDYX202101038.htm LIN Y J, HAN B, MAI Y Y, et al. Progress on the mechanism of scar formation and development after deep trauma and the treatment of exosomes derived from stem cells[J]. Journal of Guangdong Pharmaceutical University, 2021, 37(1): 142-147. https://www.cnki.com.cn/Article/CJFDTOTAL-GDYX202101038.htm
[18]	SHI K, WANG F Z, XIA J H, et al. Pirfenidone inhibits epidural scar fibroblast proliferation and differentiation by regulating TGF-beta 1-induced Smad-dependent and-independent pathways[J]. Am J Transl Res, 2019, 11(3): 1593-1604.
[19]	SU L L, ZHENG J P, WANG Y, et al. Emerging progress on the mechanism and technology in wound repair[J]. Biomed Pha, 2019, 117: 109191. DOI: 10.1016/j.biopha.2019.109191.
[20]	洪武, 李少峰, 林钰梅. 网状中厚皮联合封闭式负压引流治疗难愈性创面疗效观察[J]. 中国医药科学, 2020, 10(3): 294-296. https://www.cnki.com.cn/Article/CJFDTOTAL-GYKX202003085.htm HONG W, LI S F, LIN Y M. Efficacy observation of mesh intermediate split-thickness skin graft combined with closed vacuum sealing drainage in the treatment of refractory wounds[J]. China Medicine And Pharmacy, 2020, 10(3): 294-296. https://www.cnki.com.cn/Article/CJFDTOTAL-GYKX202003085.htm