摘要：
Objective To establish a method for repairing extremities with extensively deep burn using large piece of fresh allogeneic scalp spliced by Meek glue combined with autologous microskin and observe its effect.Methods Medical records of two male patients with extremely extensive deep burn admitted to our hospital from May to November in 2018 were retrospectively analyzed.Two patients aged 44 and 25 years respectively,with total burn area of 90％ and 97％ total body surface area (TBSA) and full-thickness burn area of 85％ and 70％ TBSA,respectively.Preoperatively,the surgical area on the extremities was calculated to estimate the necessary amount of allogeneic scalp and Meek miniature skin.The large piece of fresh allogeneic scalp spliced by Meek glue combined with autologous microskin was prepared according to the methods described as follows.Thin medium-thickness fresh scalps with 3％ TBSA and 0.30-0.35 mm in depth were harvested from each donor and spliced into a large piece with epidermis upward by spraying Meek glue.Then the spliced scalp was punched after covered with a single-layer gauze.Autologous microskin was transported onto the dermis of fresh large piece of allogeneic scalp by traditional floating method.Bilateral extremities with full-thickness burn of two patients were selected for self-control.The left upper extremity was denoted as treatment group while the right upper extremity was denoted as control group in Patient 1.The right lower extremity was denoted as treatment group while the left lower extremity was denoted as control group in Patient 2.Wounds in the treatment group were treated with fresh large piece of allogeneic scalp spliced by Meek glue and autologous microskin with expansion ratio of 1∶15 after escharectomy,while wounds in control group received grafting of Meek miniature skin with expansion ratio of 1∶6 and or 1∶9 after escharectomy.The donors of allogeneic scalp were 32 males who were the relatives or friends of the patients,aged 21-50 years,with scalp area of (548 ±48) cm2.The healing conditions of donor sites of scalp were observed on post operation day 10,and were followed up within 3 months after operation to observe whether forming alopecia and hypertrophic scar or not.Wound healing condition was evaluated during follow-up in post operation week (POW) 2-5 and 4 months after operation.Wound coverage rates were calculated in both treatment and control groups in POW 2,3,4,and 5.Results The donor sites of all allogeneic scalp of donors healed completely on post operation day 10.There was no alopecia or hypertrophic scar within 3 months after operation for follow-up.In POW 2,allogeneic scalp grafts basically survived in treatment group without obvious exudation,and most of the Meek miniature skin survived in control group with obvious exudation.Part of allogeneic scalp grafts dissolved and detached in treatment group in POW 3,and the surviving grafts scabbed.The eschar detached and new epithelium was observed in treatment group in POW 4 and 5.In POW 3-5,surviving Meek miniature skin in control group creeped and was incorporated,and the wounds shrank.Hypertrophic scar was observed in both treatment and control groups 4 months after operation,without obvious difference in scar as a whole.The wound coverage rates were respectively 84％-98％ and 76％-92％ in treatment group of two patients in POW 2-5,close to or higher than those of control group (35％-97％ and 28％-81％,respectively).Conclusions The study establishes a novel method for splicing fresh allogeneic scalps into a large piece as the covering of microskin,which has good effect for repairing extensively deep burn wounds.Considering that allogeneic skin is scarce,this method may be a new option in clinical treatment for extensively deep burn patients.%目的 创建应用胶连大张新鲜异体头皮联合自体微粒皮修复大面积深度烧伤患者四肢创面的方法及其疗效观察. 方法 回顾性分析笔者单位2018年5-11月收治的2例特大面积深度烧伤男性患者的病历资料,年龄分别为44、25岁,烧伤总面积分别为90％、97％体表总面积(TBSA),其中Ⅲ度烧伤面积分别为85％、70％ TBSA.术前计算四肢手术面积、预估异体头皮及Meek微型皮片需求量;制备胶连大张新鲜异体头皮加自体微粒皮,其方法为每名供皮者切取薄中厚头皮3％ TBSA(厚0.30～0.35 mm),表皮面向上拼接成大片状,喷涂Meek胶水并将单层纱布贴附于表皮面后行皮片打孔,自体微粒皮采用传统漂浮法转移至胶连大张新鲜异体头皮真皮面.2例患者选取双侧Ⅲ度烧伤肢体进行自身对照,例1患者的左上肢设为治疗组、右上肢设为对照组,例2患者的右下肢设为治疗组、左下肢设为对照组.治疗组创面切痂后采用胶连大张新鲜异体头皮联合自体微粒皮修复,微粒皮扩展比为1∶15;对照组创面切痂后移植Meek微型皮片修复,扩展比为1∶6和/或1∶9.异体头皮供应者为患者亲朋,男性,32名,年龄21 ～50岁,头皮面积为(548±48)cm2.术后10d观察头皮供应者供皮区愈合情况,术后3个月随访有无秃发及瘢痕增生等情况.评估术后2～5周及4个月随访时创面愈合情况,计算治疗组及对照组术后2、3、4、5周的创面覆盖率. 结果 术后10 d,头皮供应者供皮区完全愈合,术后3个月随访无秃发与瘢痕增生.术后2周,治疗组异体头皮基本完全成活,创面无明显渗出;对照组大部分Meek微型皮片成活,创面渗出明显.术后3周治疗组部分异体头皮溶脱,成活皮片成痂;术后4、5周痂皮脱落,可见新生上皮.术后3～5周,对照组成活Meek微型皮片爬行、融合,创面逐步缩小.术后4个月,治疗组及对照组均可见瘢痕增生,2组间瘢痕整体上无明显差异.术后2～5周,2例患者的治疗组创面覆盖率分别为84％ ～ 98％、76％ ～ 92％,接近或优于对照组的35％～97％、28％ ～81％. 结论 本研究创新性建立了将条状新鲜异体头皮胶连成大张皮片作为微粒皮覆盖物的方法,将其用于修复大面积深度烧伤创面,疗效较佳.在异体皮源不足的情况下,为大面积深度烧伤患者的临床救治提供了一种新选择.
