特重度烧伤86例自体供皮区分析

目的：观察分析重度烧伤患者不同部位自体皮供区、二茬皮供皮的特点,达到尽可能合理利用供区、较好发挥供区效率的目的.方法：选择烧伤总面积≥70%TBSA且Ⅲ度面积≥20%TBSA患者86例,采用头皮区、足底部、腹部、臀部及其他部位作为自体皮供区,部分同时切取二茬头皮,进行微粒皮或/及皮片移植,观察受区、供区愈合情况并分析.结果：86例患者死亡5例,自动出院2例,痊愈79例.微粒皮移植一层头皮、二茬头皮后创面上皮化率差异无显著性（82.7±10.3）% vs.（81.0±10.0）%,P＞0.05],但一层头皮与二茬头皮供区术后完全上皮化时间差异有显著性（7.3±2.2）d vs.（11.6±3.7）d,P＜0.05];二茬头皮用于肉芽创面植皮成活率低,平均（42.6±12.8）%.足底二茬皮微粒皮移植后,受区色素缺失且不形成皮脂脓肿,而一层足底皮片移植后有明显角质层过度生长表现.腋窝及耻骨联合区皮片特点近似头皮.结论：对有限的自体皮供区进行规划使用、尽可能使用二茬皮作微粒皮移植、加强综合治疗提高移植皮片成活率,是救治大面积深度烧伤过程中充分利用供区的有效措施.

Analysis on autologous skin donor area for severe burn in 86 cases

Objective：To analyze the characteristics of different body area serving as autologous skin donor site, and for the second harvest of skin in patients with severe burn trauma, for the purpose of optimizing autologous skin donor area. Method=Eighty-six severe burn patients with burn area ≥70% total body surface area （TBSA）, and full-thickness burn area ≥ 20% TBSA were selected. The autologous skin donor area was respectively the scalp, the plantar area, the abdominal wall, the buttock area and other areas. As the same time, in a part of the patients second harvest of epithelium was taken from the scalp. All the harvested epithelium was transplanted in the form of ＂micro-skin＂ or in sheet form. The healing of the donor sites and receiving sites were observed. Result：Among 86 cases, 5 patients died, 2 patients was discharged on their own wish, and 79 patients cured. There was no difference in the rate of epithelialization of wounds between the first harvest from the scalp （82.7± 10.3） ~] and the second harvest from scalp（81.0± 10.0）% ] transplanted in ＂micro skin＂ form （P〉0.05）, but there was significant difference in the time of complete epithelialization between transplantation of first harvest from the scalp （7.3 ± 2. 2） days] and the second harvest from the scalp （11. 6± 3. 7） days] after grafting （P〈0.05）. The successful transplantation rate for granulation wounds with the second harvest from scalp was low mean （42.6± 12.8）%]. After ＂micro-skin＂ grafting with the second harvest from the plantar skin, hypopigmentation was observed, but no sebaceous cyst was found. The first harvest from plantar skin served as ＂micro- skin＂ transplantation showed obvious excessive corneal formation. Skin grafts harvested from armpit and pubic area showed the similar characteristics of the scalp. Conclusions： For patients with extensive and deep burn, it is allowed to graft the wounds with second harvest of epithelium from the donor area in the form of ＂micro-skin＂ grafting, and measures should be taken to improve the survival rate of skin grafts. It is an effective measure to utilize fully the limited autologous donor site.