腹前外侧壁穿支皮瓣修复下肢大面积组织缺损的临床研究

目的 探讨腹前外侧壁穿支皮瓣修复下肢大面积组织缺损的临床效果。 方法 2017年1月~2020年12月对13例下肢大面积皮肤和软组织缺损的患者采用腹前外侧壁穿支皮瓣手术进行修复,创面缺损面积为8.0 cm×5.0 cm~ 20.0 cm×17.0 cm,皮瓣切取面积6.0 cm×9.0 cm~18.0 cm×21.0 cm;皮瓣供区均直接分层缝合。术后观察创面闭合、皮瓣成活与供区愈合情况,定期随访皮瓣外观、质地、肢体功能恢复情况。 结果 本组12例皮瓣顺利成活,皮瓣色泽与周围正常皮肤接近,皮瓣外形基本满意;1例腹壁下动脉穿支皮瓣游离移植患者术后皮瓣发生静脉危象,手术探查吻合静脉后皮瓣成活,边缘坏死1.5 cm,换药处理后愈合;全部患者创面受区与腹壁供区创口Ⅰ期愈合。8例患者患肢功能活动良好,5例皮瓣位于关节部位长期制动因而关节活动部分受限。 结论 腹前外侧壁穿支皮瓣具有皮瓣供区血供来源稳定,供区位置隐蔽、可提供较大面积皮肤和组织等优点,对于修复下肢大面积组织缺损疗效可靠。     

瘢痕移除后瘢痕皮回植原位皮肤再生治疗增生性瘢痕

背景:已有的研究表明原位皮肤再生法可使深Ⅱ度以内烧伤创面和供皮区创面生理愈合无瘢痕,可促进Ⅲ度烧伤创面坏死组织液化排除、移植皮生长、减少减轻瘢痕,在瘢痕移除创面使用原位皮肤再生法以达到明显减轻瘢痕症状、减少瘢痕的效果,未见相关报道。目的:观察瘢痕移除原位皮肤再生法治疗增生性瘢痕的效果。方法:选择烧伤或创伤后出现多处增生性瘢痕的患者32例,男25例,女7例;年龄16~52岁;瘢痕病程1~11年。每例选择2处瘢痕相似的部位,进行自身对照。实验组采用瘢痕移除、瘢痕皮回植后应用美宝湿润烧伤膏药纱覆盖的原位皮肤再生法治疗;对照组采用瘢痕移除、瘢痕皮回植后应用传统凡士林覆盖治疗。观察比较疗效,应用温哥华瘢痕评估量表评估瘢痕增生情况。结果与结论:两组回植的瘢痕皮均成活。实验组创面愈合速度和质量优于对照组(P0.05);瘢痕移除后6个月,实验组温哥华瘢痕评估量表评估均优于对照组(P0.05,P0.01),瘢痕所致的疼痛、瘙痒等症状消失,皮片平整且颜色较回植前明显改善,与周围皮肤接近。结果提示对自体皮源不足、瘢痕面积大的增生性瘢痕患者或不愿增加新的供皮区创面患者,应用瘢痕移除瘢痕皮回植原位皮肤再生的方法治疗是一种较理想的方法。     

胫后动脉踝上穿支皮瓣修复足踝部创面

目的　报道胫后动脉踝上穿支皮瓣修复足踝部创面的临床效果。 方法　对13例足踝部创面的患者,采用胫后动脉踝上穿支皮瓣转位修复术,其中足背创面5例,足跟部创面3例,踝部创面5例。4例急诊外伤创面伴有骨、肌腱外露者急诊修复。5例急诊创面采用VSD负压吸引后亚急诊行皮瓣修复, 4例为术后皮肤坏死,二期行皮瓣修复。皮肤缺损面积为1.5 cm×2.0 cm~7.0 cm×14.0 cm,切取皮瓣面积为2.5 cm×3.5 cm~8.0 cm×15.0 cm。 结果 本组13例皮瓣全部成活,供区植皮均成活。术后随访时间6~18个月,平均10个月。皮瓣质地接近周围皮肤,外观无臃肿。供区皮肤直接缝合者,术后瘢痕较小;供区植皮者,无明显瘢痕增生。踝关节活动良好,患肢均可负重行走。 结论　采用胫后动脉踝上穿支皮瓣转位修复足踝部创面,具有手术操作简单、安全的特点,是一种较好的术式。     

改良预扩张颈横动脉皮支皮瓣修复面颈部瘢痕的临床应用

目的探讨在上胸部预置软组织扩张器并形成以颈横动脉皮支为优势供血的扩张皮瓣,转移修复面颈部烧伤后的瘢痕畸形的临床应用。 方法选取2010年6月至2018年6月,空军军医大学西京医院烧伤与皮肤外科修复的面颈部瘢痕患者22例,所有患者均存在不同程度的面、颈部瘢痕伴挛缩畸形,Ⅰ期手术根据患者上胸部条件,分别于单侧或双侧上胸部埋置200～600 mL扩张器,同时术中电凝破坏胸廓内动脉及胸肩峰动脉在该区域的分支。Ⅱ期手术在进行瘢痕切除松解后,根据创面大小设计以颈横动脉皮支为蒂的带蒂/岛状皮瓣,转移到受区,供区拉拢缝合。 结果本组22例患者,共设计岛状皮瓣15个,带蒂皮瓣13个,皮瓣均全部成活,术后效果满意。 结论采用改良后的预扩张颈横动脉皮支皮瓣,血运可靠,旋转灵活,是修复面颈部瘢痕畸形较好的治疗方法。     

整复大面积瘢痕性秃发的临床经验

目的:总结和介绍大面积瘢痕性秃发整形修复的临床经验。方法:应用皮肤组织扩张术的方法,扩充有头发的头皮组织,切除秃发区的瘢痕,用推进或旋转方式修复瘢痕性秃发共32例,秃发瘢痕的面积均超过100cm~2,其中秃发面积最大23×15cm和22cm×12cm。结果:全部病例均能消除秃发的瘢痕,术后随访1～2年,头发生长良好。结论:组织扩张术是整复大面积瘢痕性秃发的首选和有效方法。     

延期原位回植术治疗严重污染的下肢大面积皮肤脱套伤

目的观察利用延期皮肤原位回植术治疗严重污染的下肢大面积皮肤脱套伤的治疗效果。方法利用延期皮肤原位回植术治疗严重污染的下肢大面积皮肤脱套伤7例。患者一期清创后,使用消毒纱布和封闭负压疗法（VAC）封闭创面,脱套的皮肤修剪成全厚皮片。使用0.1%苯扎溴铵消毒皮肤后,采用湿润的庆大霉素生理盐水纱布包裹皮片,置入4℃冰箱储存,延期3d后,创面再次清创并回植储存的脱套皮肤。结果按照皮片成活率进行疗效评定,1例为优,6例为良,皮片平均成活率为（82.14±5.81）%。对所有病例随访7个月至2年,观察回植皮肤色泽略深,外观接近正常,皮肤有汗毛生长,感觉接近正常。结论使用延期皮肤原位回植术可以有效地治疗严重污染的下肢大面积皮肤脱套伤。     

皮肤扩张术修复头皮合并颅骨缺损

目的探讨头皮合并颅骨缺损的修复方法。方法对2000年至2007年治疗的6例头皮合并颅骨缺损患者，采用皮肤扩张术修复头皮，钛网修补颅骨缺损。结果6例患者中，1例患者出现皮瓣下积液，经抽吸、加压包扎后愈合；其余病例未出现感染、血肿及皮瓣坏死等并发症，外观满意。结论皮肤扩张术和钛网联合应用是修复头皮合并颅骨缺损的较好方法。     

增强CT三维成像在扩张皮瓣修复小儿体表肿物切除后继发创面中的应用

目的探讨增强CT三维成像在扩张皮瓣修复小儿体表肿物切除后继发创面中的辅助作用。 方法选择2016年10月至2019年9月国家儿童医学中心 首都医科大学附属北京儿童医院烧伤整形科收治的29例体表肿物(血管瘤与脉管畸形、色素痣、皮脂腺痣)切除后需要通过扩张皮瓣修复继发创面的患儿。所有患儿均Ⅰ期行软组织扩张器置入术,扩张器完成注水扩张后对扩张部位行增强CT三维成像,获得供区皮瓣血管分支的三维图像来指导扩张皮瓣设计。Ⅱ期手术行体表肿物切除、扩张器取出、扩张皮瓣转移修复继发创面,供区直接拉拢缝合,带蒂皮瓣远位转移时则需择期手术断蒂。收集病例资料,统计扩张皮瓣数量及其分布情况,测量转移扩张皮瓣面积,观察扩张皮瓣增强CT三维成像显示的血管分布及造影剂碘海醇不良反应情况,观察皮瓣转移术后皮瓣成活情况;门诊随访4～12个月,观察转移扩张皮瓣的颜色和质地情况。 结果本组29例患儿共设计获取53个扩张皮瓣,其中头部7个、面颈部10个、躯干20个、四肢16个,18例患儿存在2个及以上的扩张皮瓣。转移扩张皮瓣面积为6 cm×5 cm～18 cm×12 cm,增强CT三维成像均显示扩张皮瓣和毗邻空间位置关系,检查过程未见不良反应,其中28个扩张皮瓣可见动脉分支供血或静脉回流。皮瓣转移术后所有扩张皮瓣成活良好,未见血运障碍。术后门诊随访4～12个月,扩张皮瓣颜色和质地与周围正常皮肤相近。 结论增强CT三维成像可辅助扩张皮瓣术前血管评估,有助于避免损伤血管主干,在扩张皮瓣修复小儿体表肿物切除后继发创面中具有一定的应用价值。     

皮肤软组织扩张术在烧伤整形外科的应用

目的观察应用皮肤软组织扩张术修复烧伤瘢痕、色素痣、秃发等病损的效果。方法应用皮肤软组织扩张术将扩张器植入头面部、颈部、四肢等处,且在与病损相邻的正常皮肤下扩张后修复病损12例,术中采用的扩张器大小及数量依病损面积而定。按每修复1cm×1cm缺损需扩张器容量5ml计算,扩张后的皮瓣设计成滑行推进皮瓣、旋转皮瓣、交错皮瓣或远距离带蒂皮瓣等。结果本组12例,其中1例皮瓣尖端部分血运障碍,其余11例外形良好,效果满意。结论扩张术是烧伤整形外科中修复创面的较好的方法。     

皮肤软组织扩张术在烧伤早期修复中的应用

皮肤软组织扩张术是将硅胶扩张器埋植于正常皮下,定时注入液体使其扩张膨胀,其表面皮肤软组织随之增殖扩展产生"额外"的皮肤组织,经供修复邻近组织缺损的手术方法.其提供的皮肤软组织与缺损区的色泽、质地、厚薄以及毛发分布相似,修复后避免了供皮区产生新的疤痕和畸形,是近年来整形外科技术的一项重大进展[1],对烧伤早期新鲜创面的修复少有报道,1993-2002年,我院引用国产器,用于尝试烧伤新鲜创面的早期修复重建,与后期整形一次完成,取得良好效果,报告如下:     

人工真皮联合自体薄层皮片移植修复下肢创伤骨外露创面

目的总结及分析人工真皮联合自体薄层皮片移植修复骨外露创面的临床效果。 方法回顾性分析武汉大学同仁医院暨武汉市第三医院烧伤科自2010年6月至2013年6月收治的11例下肢创伤后骨外露患者的临床资料,男10例,女1例,年龄为23～76岁,所有患者均行一期扩创及人工真皮种植,二期行自体薄层皮片移植修复,通过评估创面恢复情况及取皮创口恢复情况综合评价治疗效果。 结果11例患者供皮区取皮后表皮再次形成时间为(15.5±2.5)d,一期手术后行二期植皮时间为(18.5±2.2)d;创面移植皮片均完好存活,愈合良好,外观平整,皮肤颜色略深于正常皮肤;2例患者供皮区域出现极轻度瘢痕,1例轻度瘢痕,余8例无明显瘢痕形成,整体效果满意。 结论人工真皮联合自体薄层皮片移植是治疗骨外露的有效方法。     

Use of Helium Plasma Flow for Healing Deep Burning Wounds

The influence of helium plasma flow on deep burning wounds healing is reviewed. The research was performed using Wistar rats. The experimental part is represented by three series of experiments. In all the series preliminarily depilated dorsal skin area was irradiated by the SUPR-M facility. The morphomechanic changes of skin under the impact of plasma flow were studied. The skin and granulating wound exposure was explored, as well as the capabilities of helium plasma flow when preparing grafts for autoplasty. During the postoperative period the influence of donor skin grafts on wound repair was tested. The criterion of plasma flow efficiency was the wound tensometry of scar forming. The experimental results of this work prove the expediency of helium plasma flow application when healing deep burns.     

脱细胞异体真皮联合自体刃厚皮修复大面积烧伤后关节部位瘢痕挛缩

目的探讨脱细胞异体真皮联合自体刃厚皮移植在大面积烧伤患者关节部位瘢痕挛缩修复中的疗效。 方法选取2017年4月至2020年4月空军军医大学第一附属医院烧伤与皮肤外科收治的12例大面积烧伤后瘢痕挛缩患者,男9例,女3例,年龄为23.0~67.0岁,烧伤面积为70.0%~95.0%总体表面积(TBSA)。患者入院完善相关术前检查后,明确拟手术切除部位,行Ⅰ期关节部位瘢痕松解,完整切除功能受限的关节部位瘢痕,使其恢复最大功能位。瘢痕切除后创面面积为10.0 cm×5.0 cm~20.0 cm×15.0 cm。脱细胞异体真皮覆盖创面,可吸收线缝合固定,封闭负压吸引7 d后行Ⅱ期手术,取自体刃厚皮覆盖于脱细胞异体真皮上缝合固定,并行封闭负压吸引。术后7 d观察皮片成活情况;创面愈合后6个月,参照《实用烧伤康复治疗学》中关于关节活动功能评定标准,采用量角器测量关节活动度,同时观察患肢肌力、感觉、外形、遗留症状、关节区域功能及供受区外观;创面愈合后6个月,根据患者情况进行临床疗效评估,同时采用自制外观满意度评分表对患者进行满意度评估。 结果术后7 d,10例患者皮片全部成活,2例患者皮片移植区域有残余创面,经换药处理后1个月内愈合。术后随访6~24个月,平均随访12个月。创面愈合后6个月,12例患者关节活动度分别最大可达：肘关节屈曲130°、伸展0、腕关节掌屈60°、背伸65°、尺偏25°、桡偏20°。所有患者患肢肌力正常、感觉良好、外形较术前有很大改观,关节区域功能较术前明显改善,受区皮肤质地柔软,颜色与周围正常皮肤接近,供皮区毛发发育未见异常。创面愈合后6个月,10例患者痊愈,2例有效。创面愈合后6个月,10例患者非常满意,2例患者满意。 结论脱细胞异体真皮联合自体刃厚皮修复大面积烧伤后关节部位瘢痕挛缩畸形,解决了患者自体中厚皮源不足的问题,术后效果好,值得推广。     

人工真皮修复骨外露创面23例效果评价

背景：近年来有应用人工真皮修复骨外露创面的报道,但其治疗效果尚不明确。 目的：评价应用人工真皮修复23例骨外露创面的治疗效果。 方法：选取北京积水潭医院烧伤科23例骨外露患者,男18例,女5例。骨外露创面清创后,进行人工真皮移植,待其成活后,进行自体薄断层皮片移植,观察人工真皮及自体断层皮片的成活情况和供皮区瘢痕增生情况。 结果与结论：所有骨外露患者中除1例女性颅骨外露部分修复外,其余患者人工真皮及自体皮片成活良好,骨外露创面均完全修复,供皮区未见瘢痕。结果提示,人工真皮修复骨外露创面效果较好。     

Meek微型皮片移植修复大面积深度烧伤

背景：Meek植皮法是近5年来引进并陆续在国内多家医院采用的一项创面修复的新技术。 目的：观察Meek微型皮片移植修复在大面积深度烧伤患者皮肤缺损的效果。 方法：对16例大面积深度烧伤创面患者,采用早期切(削)痂后及晚期肉芽创面Meek植皮法植皮,其中6例选取Ⅲ度烧伤面积30%左右患者同一个体行相同面积Meek微型皮片植皮法,和自体小邮票植皮作为对照。 结果与结论：采用Meek微型皮片植皮法皮片成活率65%~95%,创面愈合时间21~65 d。Meek微型皮片与自体邮票植皮相比缩短了手术时间,节省了皮源,创面愈合后瘢痕平整,挛缩率低,关节功能恢复良好。     

Fibroblast growth factor-2 regulates myocardial infarct repair: effects on cell proliferation, scar contraction, and ventricular function

Fibroblast growth factor-2 (FGF2, bFGF) has been proposed to regulate wound healing and angiogenesis, but skin wound healing in FGF2-knockout (FGF2-KO) animals is only slightly delayed. To determine the role of FGF2 in myocardial infarct repair, we studied the evolution of left ventricular geometry, cell proliferation, matrix content, and cardiac function in mice lacking or overexpressing (FGF2-Tg) FGF2. Despite having no effect on initial infarct size, deletion of FGF2 resulted in reduced fibroblast proliferation and interstitial collagen deposition, decreased endothelial proliferation and vascular density, and decreased cardiomyocyte hypertrophy. Furthermore, FGF2-KO mice demonstrated a complete absence of scar contraction, resulting in increased final infarct size and marked increases in chamber size and infarct expansion. These deficits ultimately impaired left ventricular dP/dt compared with wild-type infarcted mice. Conversely, overexpression of FGF2 increased fibroblast proliferation and collagen deposition, accelerated endothelial proliferation, and enhanced cardiomyocyte hypertrophy after infarction. These changes curbed infarct expansion and preserved left ventricular function. Thus, FGF2 is an important regulator of cell proliferation, angiogenesis, collagen synthesis, myocyte hypertrophy, scar contraction, and, ultimately, left ventricular contractile function during infarct repair. FGF2 may be more important in healing of infarcts compared with skin wounds because of the mechanical stress under which infarcts heal.     

Differential expression of fibromodulin, a transforming growth factor-beta modulator, in fetal skin development and scarless repair

Transforming growth factor-beta (TGF-beta1, -beta2, and -beta3) has been implicated in the ontogenetic transition from scarless fetal repair to adult repair with scar. Generally, TGF-beta exerts its effects through type I and II receptors; however, TGF-beta modulators such as latent TGF-beta binding protein-1 (LTBP-1), decorin, biglycan, and fibromodulin can bind and potentially inhibit TGF-beta activity. To more fully explore the role of TGF-beta ligands, receptors, and potential modulators during skin development and wound healing, we have used a rat model that transitions from scarless fetal-type repair to adult-type repair with scar between days 16 and 18 of gestation. We showed that TGF-beta ligand and receptor mRNA levels did not increase during the transition to adult-type repair in fetal skin, whereas LTBP-1 and fibromodulin expression decreased. In addition, TGF-beta1 and -beta3; type I, II, and III receptors; as well as LTBP-1, decorin, and biglycan were up-regulated during adult wound healing. In marked contrast, fibromodulin expression was initially down-regulated in adult repair. Immunostaining demonstrated significant fibromodulin induction 36 hours after injury in gestation day 16, but not day 19, fetal wounds. This inverse relationship between fibromodulin expression and scarring in both fetal and adult rat wound repair suggests that fibromodulin may be a biologically relevant modulator of TGF-beta activity during scar formation.     

Scar‐free cutaneous wound healing in the leopard gecko,Eublepharis macularius

Cutaneous wounds heal with two possible outcomes: scarification or near‐perfect integumentary restoration. Whereas scar formation has been intensively investigated, less is known about the tissue‐level events characterising wounds that spontaneously heal scar‐free, particularly in non‐foetal amniotes. Here, a spatiotemporal investigation of scar‐free cutaneous wound healing following full‐thickness excisional biopsies to the tail and body of leopard geckos (Eublepharis macularius) is provided. All injuries healed without scarring. Cutaneous repair involves the development of a cell‐rich aggregate within the wound bed, similar to scarring wounds. Unlike scar formation, scar‐free healing involves a more rapid closure of the wound epithelium, and a delay in blood vessel development and collagen deposition within the wound bed. It was found that, while granulation tissue of scarring wounds is hypervascular, scar‐free wound healing conspicuously does not involve a period of exuberant blood vessel formation. In addition, during scar‐free wound healing the newly formed blood vessels are typically perivascular cell‐supported. Immunohistochemistry revealed widespread expression of both the pro‐angiogenic factor vascular endothelial growth factor A and the anti‐angiogenic factor thrombospondin‐1 within the healing wound. It was found that scar‐free wound healing is an intrinsic property of leopard gecko integument, and involves a modulation of the cutaneous scar repair program. This proportional revascularisation is an important factor in scar‐free wound healing.     

Fabrication and characterization of the porous duck’s feet collagen sponge for wound healing applications

Abstract

There are several artificial dermis commonly use to cover the wound and promote healing. The major goal of wound management is fast and scarless healing. However, there is no ideal skin substitute, that is effective to accelerate wound healing without scar formation. Artificial dermis substitute also has some drawbacks, such as high cost, insufficient available period and donor pathogen infection. To overcome these problems, we developed duck’s feet collagen (DFC) sponge as artificial dermal substitutes for the treatment of full-thickness skin defects. We measured these DFC sponge’s comparative characteristics and performances with an artificial dermis Colladerm by carried out SEM-EDX analyze, water-binding abilities and porosity test. Biocompatibility test was also performed using CCK-8 cytotoxicity assay. We also evaluated its wound healing effects for a full-thickness skin wound and compared with Colladerm in a rat model. Histological studies were carried via hematoxylin and eosin and Masson’s Trichrome staining. Although the wound healing effect of the DFC sponge was almost similar to that of Colladerm, the DFC sponge did not induce scar formation and wound contracture like Colladerm. We suggest that DFC sponge can be used as an ideal dermal substitute to the treatment of full-thickness skin wound.