王浩 姚刚 俞书婷 张轩龙

[摘要]目的：探討Meek微型皮片移植术治疗大面积深度烧伤患者的临床疗效，并分析失败案例的原因。方法：选取笔者医院2015年6月-2019年3月收治的50例大面积深度烧伤患者。将50例大面积深度烧伤患者随机分为对照组和观察组，各25例。所有患者入院后均给予清创、抗感染、补液等一般治疗。其中对照组使用邮票植皮术治疗。观察组采用Meek微型皮片移植术治疗。观察并记录两组患者创面愈合时间、皮片融合时间，检测两组患者的瘢痕硬度和瘢痕厚度，并比较两组患者皮片愈合效果。结果：治疗后，观察组的创面愈合时间、皮片融合时间、瘢痕硬度、瘢痕厚度均明显低于对照组，差异有统计学意义（P<0.05）。观察组优良愈合率（80.00%）明显高于对照组（64.00%），且观察组愈合失败率（8.00%）低于对照组（16.00%），差异有统计学意义（P<0.05）。结论：采用Meek微型皮片移植术患者的相关指标均优先于传统邮票植皮术患者，且能够明显提升皮片优良愈合率和成活率。导致Meek微型皮片移植术失败的原因是手术时机、坏死组织清除程度和感染因素。

[关键词]Meek微型皮片移植术;深度烧伤;大面积;传统邮票植皮术;疗效;瘢痕;失败原因

[中图分类号]R644    [文献标志码]A    [文章编号]1008-6455（2021）01-0039-03

Effect of Meek Skin Graft in Repairing Large Scare Deep Burn Wounds

WANG Hao，YAO Gang，YU Shu-ting，ZHANG Xuan-long

（Department of Burn and Plastic Surgery，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，Jiangsu，China）

Abstract： Objective  To investigate the clinical efficacy of Meek skin grafting technique in the treatment of patients with large scale deep burns， and to analyze the cause of failure. Methods  50 patients with large scare deep burn treated in our hospital  were selected from June 2015 to March 2019， and divided into the control group （n=25） and the observation group （n=25）. All patients received general debridement， anti-infection， and fluid replacement after admission. The control group was treated with stamp skin grafting. The observation group was treated with Meek skin grafting technique. The wound healing time and skin fusion time of the two groups of patients were observed and recorded. The scar hardness and scar thickness of the two groups of patients were detected， and the skin healing effects of the two groups of patients were compared. Results  After treatment， the wound healing time， skin fusion time， scar hardness and scar thickness in the observation group were significantly lower than those in the control group， the differences were statistically significant （P<0.05）. After treatment， the excellent healing rate in the observation group （80.00%） was significantly higher than that in the control group （64.00%）， and the healing failure rate in the observation group （8.00%） was lower than that in the control group （16.00%）， the differences were statistically significant （P<0.05） . Conclusion  Meek skin grafting technique were preferred over traditional stamp skin grafting， and could significantly improve the excellent healing rate and survival rate of the skin. The reasons for the failure of Meek skin grafting technique were the timing of operation， the degree of necrotic tissue removal and the infection factors.

Key words： Meek skin grafting technique; deep burn; large area; traditional stamp skin grafting; curative effect; scar; causes of failure

烧伤主要是指高温、电流和辐射等造成的皮肤和黏膜组织损害[1-2]。而大面积深度烧伤则因患者受创面积过大，自体皮源有限，再加上异体皮源较少，导致其临床治疗难度较大[3-4]。大面积深度烧伤后，患者创面长期裸露在外，极易引起内环境絮乱等并发症，甚至感染引发脓毒症导致多器官功能障碍而死亡[5-6]。由于其烧伤后皮肤再生系统受损，创面难以自愈，因此需进行手术植皮治疗来封闭创面[7]。目前临床上治疗大面积烧伤的传统方法是郵票植皮术，此方法对受体皮要求较低，但由于其操作繁琐、时间长、换药复杂，大大限制了其应用范围[8]。……