摘要
目的:探讨双层人工真皮联合自体瘢痕表皮移植修复手足烧伤后瘢痕挛缩的疗效。方法:选择2021年6月-2023年6月于笔者医院就诊的108例手足烧伤后瘢痕挛缩患者为研究对象,依照患者意愿,按随机数字表法分为观察组和对照组,各54例。观察组采用双层人工真皮联合自体瘢痕表皮移植,对照组采用自体中厚皮移植。统计比较两组术后皮片存活率、术区创面感染率、创面愈合时间、瘢痕评分[温哥华瘢痕量表(Vancouver Scar Scale,VSS)]、创面炎症因子[γ干扰素(IFN-γ)、肿瘤坏死因子-α(TNF-α)、白介素-1(IL-1)]及生长细胞因子[血管内皮生长因子(VFGF)、转化生长因子β_(1)(TGF-β_(1))]水平。结果:两组皮片存活率比较差异无统计学意义(P>0.05);观察组术区创面感染率为3.70%,小于对照组的16.67%(P<0.05)。观察组受皮区完全愈合时间明显长于对照组(P<0.05),但观察组供皮区愈合时间明显短于对照组(P<0.05)。术后6个月及术后12个月,观察组受皮区VSS评分高于对照组(P<0.05),但同期观察组供皮区VSS评分均低于对照组(P<0.05)。术后7 d,两组患者炎症因子水平差异无统计学意义(P>0.05),但观察组的VFGF、TGF-β_(1)水平均高于对照组(P<0.05)。结论:采用双层人工真皮联合自体瘢痕表皮移植修复,表现出与中厚皮片移植相似的存活率和较低的术区创面感染率,能够增加术后VFGF、TGF-β_(1)等生长因子的表达,不仅对改善手足烧伤患者瘢痕挛缩有较好的效果,还可缩短创面愈合时间,减少供区瘢痕形成。
Objective To explore the effect of double-layer artificial dermis combined with autologous scar epidermal transplantation on the repair efect of scar contracture after burns on hands and feet.Methods From June 2021 to June 2023,108 patients with scar contracture after burns in our hospital were selected as the research objects.According to the wishes of the patients,they were divided into the observation group and the control group according to the random number table method,with 54 cases in each group.The observation group used double-layer artificial dermis combined with autologous scar epidermal transplantation,while the control group used autologous medium-thickness skin transplantation.The postoperative skin graft survival rate,wound infection rate,wound healing time,VSS score,and levels of wound inflammatory factors[γInterferon(IFN-γ),Tumor Necrosis Factor-α(TNF-α),Interleukin-1(IL-1)]and growth factors[Vascular Endothelial Growth Factor(VFGF),Transforming Growth Factorβ_(1)(TGF-β_(1))]were statistically compared between the two groups.Results There was no significant diference in skin graft survival rate between the two groups(P>0.05).The wound infection rate in the observation group was 3.70%,which was lower than 16.67%in the control group(P<0.05).The complete healing time of the recipient site in the observation group was significantly longer than that in the control group(P<0.05),but the healing time of the donor site in the observation group was significantly shorter than that in the control group(P<0.05).At 6 and 12 months after operation,the VSS scores of the skin recipient site in the observation group were higher than those in the control group(P<0.05),but the VSS scores of the skin donor site in the observation group were lower than those in the control group(P<0.05).On the 7th day after operation,there was no significant diference in the levels of inflammatory factors between the two groups(P>0.05),but the levels of VFGF and TGF-β_(1) in the observation group were higher than those in the control group(P<0.05).Conclusion The use of double-layer artificial dermis combined with autologous scar epidermal transplantation shows a survival rate similar to that of medium-thickness skin grafting and a lower wound infection rate in the surgical area.It can increase the expression of growth factors such as VFGF and TGF-β_(1) after surgery,not only it has a good efect on improving scar contracture in patients with burns on hands and feet,it can also shorten the wound healing time and reduce scar formation in the donor area.
作者
马雷
杨加保
赵政男
郭加平
MA Lei;YANG Jiabao;ZHAO Zhengnan;GUO Jiaping(Department of Burn and Plastic Surgery,Suqian First People's Hospital,Suqian 223800,Jiangsu,China)
出处
《中国美容医学》
2026年第1期33-37,共5页
Chinese Journal of Aesthetic Medicine
关键词
双层人工真皮
瘢痕
表皮移植
烧伤
瘢痕挛缩
double-layer artificial dermis
scar
epidermal graft
burn
scar contracture
