人工真皮在手部瘢痕挛缩整形中的应用.docVIP

精品论文 参考文献 人工真皮在手部瘢痕挛缩整形中的应用 丁先超 沈峻 孙晖 邰宁正 刘昌 孙炳伟（江苏大学附属医院烧伤科　江苏镇江　212001） 【中图分类号】R658.2【文献标识码】A【文章编号】1672-5085（2011）46-0140-02 【摘要】目的 探讨使用人工真皮（皮耐克）结合自体皮修复手部瘢痕挛缩畸形的治疗效果。方法　回顾分析两组手部瘢痕畸形的手术治疗效果；A组：皮耐克修复组，7例，采用皮耐克(双层结构人工皮肤)与自体刃厚皮片复合移植。B组：自体中厚皮片治疗组，7例，采用自体中厚皮片植皮修复。对比评估两组手部植皮区存活皮片外观，随访近期、远期手部功能恢复情况，供皮区愈合情况、色素、疤痕生长情况。结果　两组病例手部植皮区皮片均成活。与B组相比，A组植皮区愈合情况好于B组，手部功能的恢复好于B组,且A组取皮区愈合情况良好。结论　采用皮耐克与自身刃厚皮片复合移植治疗手部瘢痕挛缩畸形，既有利于创面愈合且有益手部功能的重建。 【关键词】手　瘢痕整形　皮耐克　自体刃厚皮 【Abstract】 purpose to disccuse the effect of repair the scar of the hand with PELNAC.Method two groups of patients with scar contraction in hand were included in this retrospective study.the patients in group A(7 cases) were treated by blade thick auto-skin grafting with the subjacent PELNAC(artificial skin with two layer structure).the patient in group B(7 cases) were repaired with split thick auto-skin grafting. The appearance and the function of the skin grafting area of the injured hands were evaluaed in short and long term after the operation，the appearance of the skin donor sites were also evaluated. result The skin grafting area of two groups were survived ,compared with group B, The appearance of skin grafting area and the hand function in group A were better than that in group B,the Prognosis of the skin-donor site were better in group A than that in group B. conclution Repairing of scar in hands with autoskin grafting and PELNAC was beneficial to wound healing，which was also helpful to the reconstruction of the hand function. 【Key words】Hand scar shaping PELNAC Blade thick auto-skin 手部瘢痕挛缩畸形是烧伤后期常见的一种并发症，表现为手部关节处瘢痕牵拉致活动受限，严重时表现为爪形手畸形。目前的治疗方法是采用瘢痕改形术或瘢痕切除植皮术矫正畸形。然而这通常需要多次手术，造成取皮区瘢痕增生畸形，取皮区愈合时间也相对过长。本科室采用皮耐克与自体刃厚皮片复合移植修复手部瘢痕挛缩畸形，取得较满意效果。通过回顾分析我科近两年来十余例手部瘢痕畸形整复的不同术式，积累皮耐克在手部瘢痕畸形整复中的应用经验，为治疗提供一种新的术式。 1　临床资料 1.1一般资料：本组患者中男性7例，女性7例，年龄15-40岁。按照部位可分为虎口部，手指，及指蹼瘢痕挛缩畸形。其中虎口部瘢痕畸形4例，手指部5例，手背部5例。7例采用瘢痕切除后皮耐克与自体刃厚皮片复合移植，7例采用瘢痕切除后中厚皮片移植。 1.2手术方式：A组：于瘢痕挛缩处设计手术切口并用美兰标记，于标记处切开至皮下，使瘢痕松解彻底。根据松解后创面的面积和形状，选