自体与冻存异体小皮片混合移植修复大面积深度烧伤创面的初步临床研究
发布时间：2018-07-16 22:25
【摘要】：背景特大面积深度烧伤由于自体皮源极度紧缺,无法短时间内修复创面,中后期创面基底肉芽组织增生、局部感染,再次皮片移植存活率低,大面积裸露创面常常面临超高代谢、脓毒血症、多器官功能障碍综合症,甚至危及生命,特大面积深度烧伤的救治目前仍是临床医师面临的重大挑战。据Robert Kraft,Wang cheng,Tuener Osler等人报道,烧伤面积60%-69%TBSA的救治成功率为87.1%,烧伤面积大于90%TBSA时救治成功率仅为47.8%,及时修复创面是提高救治成功率的关键之一。采用传统的大张皮植皮、邮票皮植皮、拉网皮植皮,虽然可以提高移植存活率、减轻瘢痕增生,尽可能恢复功能,但是由于扩展比例不足,不适合大面积深度烧伤创面的修复。目前修复特大面积深度创面的方法主要包括自体表皮细胞培养移植、Meek植皮、中国式的微粒皮移植、大张异体皮打洞自体小皮片嵌植等,然而,自体表皮细胞培养移植由于缺乏真皮后期瘢痕严重,后三者因覆盖生物膜或异体皮,分泌物不易引流,增加感染可能,皮片存活率不稳定。综上所述,现阶段仍缺乏移植存活率稳定、扩大面积比例大、愈合质量高的创面修复技术。因此,迫切需要寻求一种能够运用较小面积自体皮源修复特大面积深度烧伤创面的方法成为烧伤修复中亟待解决的难题。本研究采用自体小皮片与冻存异体小皮片混合移植的方法,经12年的临床观察表明,该方法使自体皮扩大比例达9-16倍,移植存活率达91.8±3.7%。而且,异体真皮长期存在,作为真皮替代物减轻了瘢痕形成。该方法为解决特大面积深度烧伤创面的修复难题提供了可供选择的方案。第一部分自体异体小皮片混合移植修复烧伤中后期大面积残余创面目的证实自体异体小皮片混合移植不仅显著提高自体皮扩增比例,而且具有较强的耐受感染能力,从而能够有效修复大面积深度烧伤创面,为烧伤中后期大面积深度创面的修复提供移植存活率高而又稳定可靠的方法。方法1.回顾性分析:2002年至2014年间本烧伤中心收治的符合本试验入选标准的65例烧伤患者。采用自体和冻存异体小皮片混合移植修复21例,采用微粒皮移植及MEEK植皮分别修复27例和17例。统计患者基本资料(性别、年龄、基础疾病、创面面积、烧伤部位、并发症),应用Excel2013表格记录相关数据。2.皮肤移植前咽拭子采集不同部位创面分泌物标本,采集标本后及时送检,测定菌株种类,计算创面细菌阳性率(细菌培养阳性创面数/创面总数×100%)。3.术后创面定期换药,观察创面愈合过程,记录创面愈合时间,计算创面愈合百分率。首先,比较混合移植组与微粒皮移植组、MEEK移植组创面愈合率的差异是否具有统计学意义;其次,分析创面愈合过程的影响因素;最后,比较混合移植组与微粒皮移植组、MEEK移植组植皮存活率稳定性差异是否具有统计学意义。4.随访观察1年—2年,采用温哥华瘢痕量表评价创面愈合质量,并比较混合移植组与微粒皮移植组、MEEK移植组之间差异是否具有统计学意义。5.采用纹身技术对异体小皮片染色,随访时间为1年-2年,免疫组化追踪异体真皮转归及作用。6.统计学方法:采用Shapiro-Wilk检验、Levene检验、T检验、Mann-Whitney U检验、Mauchly检验、Mann-Whitney U、卡方检验或者Fisher确切概率法、多元线性回归、Logistic回归分析进行统计学分析。结果1.回顾分析2002年到2014年间65名严重烧伤患者,男、女之比为47:18,平均年龄为35.2±6.7岁,平均烧伤面积84.1±7.5%TBSA,伤后20-37d残留大面积裸露创面,平均为61.1±8.1%TBSA。包括43名创面溶痂的患者,22名植皮失败的患者。其中8名患者伴有高血压,4名伴有糖尿病,2名为肥胖患者。所有患者均无合并有其他皮肤疾病、免疫低下或缺陷等基础疾病,无激素、免疫抑制剂等用药史。2.植皮前创面局部细菌培养显示自、异体混合移植、微粒皮移植及MEEK植皮创面的阳性率分别为94.1%、92.2%、89.5%,细菌分布主要为Staphylococcus aureus,Acinetobacter baumannii,Streptococcus viridans,pseudomonas aeruginosa and coagulase-negative staphylococci。3.肉眼观察可见:混合移植术后7-10天自体皮片开始向四周扩展,14-20d自体皮片表皮扩展融合,异体表皮逐渐被自体表皮爬行、替代。3-4周,经大体观察,异体真皮仍清淅可见,随移植时间延长,异体真皮与自体真皮界限模糊。残余创面在烧伤后21-59天进行植皮,混合移植组、微粒皮移植组、MEEK皮移植组平均修复创面面积分别为27.0%TBSA、25.0%TBSA、24.0%TBSA。混合移植组创面愈合率明显高于微粒皮移植组和MEEK移植组,分别为91.8±3.7%、66.5±6.9%、75.4±5.1%(P0.001)。多重线性回归分析结果显示植皮方式、植皮部位、基础疾病可影响创面的愈合率,在同等条件下,微粒皮和Meek植皮的创面愈合率较自、异体小皮片混合移植分别低24.567%、16.799%。经Levene检验,混合移植创面愈合率稳定性(SD=3.7)较微粒皮移植(SD=6.9)高(F=23.779,P=0.000),而与MEEK植皮创面愈合率(F=5.726,P=0.019)相比无显著差异。4.随访1-2年,温哥华瘢痕量表得分混合移植组明显低于微粒皮移植组,有统计学意义(混合组:n=20,4.20±1.47;微粒皮组:n=16,6.00±2.37,P=0.008)。混合移植组与MEEK移植组之间无统计学意义(MEEK组:n=12;4.33±1.61,P=0.813)。5.移植含有纹身图案的异体皮,术后2个月至2年,可见纹身颗粒位于真皮层内,胶原纤维排列规则,周围组织未见明显炎症反应,真皮乳突样结构形成,与临近的自体真皮结构相似。结论自体与冻存异体小皮片混合移植显著提高了自体皮的扩大比例,移植后存活率高而稳定,而且异体真皮长期存在可作为真皮替代物,改善创面愈合质量。为利用有限的供皮区尽快修复烧伤中后期大面积深度创面提供了可供选择的方法。第二部分典型病例报道1.特大面积烧伤患者救治,保证皮片移植即手术成功至关重要基于第一部分,我们得出采用自体异体小皮片混合移植,能够快速、有效的修复烧伤中后期大面积残余创面。显而易见,保证皮片移植存活即手术成功至关重要。为提高特大面积深度烧伤患者的救治效果,我们于早期即采用自体异体小皮片混合移植,混合移植皮片存活率高,且存活率稳定,进一步缩短救治时间,显著提高患者救治成功率,降低患者住院费用。接下来报道2014年8月2日昆山爆炸事件烧伤患者采用自体异体小皮片混合移植的救治典型病例。2.昆山爆炸事件典型病例报道3名患者烧伤面积均大于90%TBSA,III度烧伤面积均大于80%TBSA。入院第一时间给予抗休克、抗感染、营养支持、换药治疗,平稳度过休克期,采取保痂治疗。采用自体异体小皮片混合移植成功修复创面。病例一:患者女性,43岁,粉尘爆燃烧伤全身98%TBSA,其中III°烧伤面积为90%TBSA。伤后第6天行MEEK植皮术,之后行4次自体与冻存异体小皮片混合移植,伤后30天残余烧伤创面约27%TBSA,伤后65天创面基本修复。病例二:患者女性,39岁,粉尘爆燃烧伤全身90%TBSA,其中III°烧伤面积为82%TBSA。伤后第8天行MEEK植皮术,之后行4次自体与冻存异体小皮片混合移植,伤后30天残余烧伤创面约20%TBSA,伤后61天创面基本修复。病例三:患者男性,46岁,粉尘爆燃烧伤全身96%TBSA,其中III°烧伤面积为90%TBSA。伤后第7天行MEEK植皮术,之后行4次自体与冻存异体小皮片混合移植,伤后30天残余烧伤创面约25%TBSA,伤后67天创面基本修复。
[Abstract]:Background extra large area deep burn, due to the extreme shortage of autologous skin source, can not repair the wound in a short time. In the middle and late stages, the wound basement granulation tissue is proliferated, local infection, and the survival rate of the skin graft is low. The large area naked wound often faces ultra high metabolism, sepsis, multiple organ dysfunction syndrome, even life threatening, mega area. Treatment of deep burn is still a major challenge for clinicians. According to Robert Kraft, Wang Cheng, Tuener Osler and others, the success rate of the treatment of burn area 60%-69%TBSA is 87.1%, and the cure rate is only 47.8% when the burn area is greater than 90%TBSA. Repairing the wound in time is one of the key factors to improve the success rate of the treatment. The skin grafting, skin grafting and skin grafting of the skin, although it can improve the survival rate, reduce the scar hyperplasia and restore the function as much as possible, but because of the insufficient expansion ratio, it is not suitable for the repair of large area deep burn wounds. At present, the methods of repairing large area deep wounds mainly include autoepidermal cell culture and transplantation, Meek skin grafting, Chinese type skin grafting, large skin graft and autologous small skin graft, however, the autologous epidermal cell culture and transplantation due to the lack of severe dermis scar, the latter three due to the cover of biofilm or allograft, the secretion is not easy to drain, the infection may be increased, the survival rate of the skin is unstable. In summary, the present stage is still lack of transplantation survival. Therefore, it is urgent to find a method that can be used to repair large area deep burn wound with small area autologous skin source. This study is a difficult problem to be solved in the repair of burn. After 12 years of clinical observation, the method made the proportion of autologous skin up to 9-16 times, the survival rate of the transplant was 91.8 + 3.7%. and the allogenic dermis existed for a long time and reduced the scar formation as a dermal substitute. This method provides a alternative solution for the repair problem of large area deep burn wounds. Part 1 autologous allograft. The mixed transplantation of small skin graft to repair large area residual wounds in the middle and late stages of burn proved that the autologous allograft transplantation not only significantly increased the proportion of autologous skin expansion, but also had a strong ability to tolerate infection, which could effectively repair large area deep burn wounds and provide migration for the repair of large area deep wounds in the middle and late period of burn. The method of planting a high and stable and reliable survival rate. Method 1. retrospective analysis: from 2002 to 2014, 65 cases of burn patients were treated in the burn center which met the standard of this test. 21 cases were repaired with autologous and cryopreserved allograft transplantation, 27 cases and 17 cases were repaired by particle skin grafting and MEEK skin grafting. Data (sex, age, basic disease, wound area, burn site, complication), using the Excel2013 table to record the relevant data of.2. skin graft before the skin transplantation to collect the secretions of different parts of the wound, and collect the specimens in time, determine the species of the strains, and calculate the positive rate of the surface bacteria (the number of bacteria culture positive wounds / the total number of wounds * 100%). The wound healing process was observed after.3., the healing time of wound healing was recorded, and the percentage of wound healing was recorded. First, whether the difference of wound healing rate in the mixed transplantation group and the particle skin graft group and the MEEK transplantation group was statistically significant; secondly, the influencing factors of the wound healing process were analyzed; finally, the mixed transplantation group was compared with that of the mixed transplantation group. Whether the difference of the survival rate stability of the skin graft survival in the MEEK transplantation group was statistically significant.4. follow-up observation for 1 to 2 years, the Vancouver scar scale was used to evaluate the healing quality of the wound, and the difference between the mixed transplantation group and the particulate skin transplantation group and the MEEK transplantation group was statistically significant.5. using tattoo technique for the small allograft The follow-up time was 1 years -2 years. The immuno histochemical tracing of allogenic dermis and.6. statistical methods: Shapiro-Wilk test, Levene test, T test, Mann-Whitney U test, Mauchly test, Mann-Whitney U, chi square test or Fisher exact probability, multivariate linear regression, Logistic regression analysis were used for statistical analysis. Results 1. retrospective analysis of 65 severely burned patients from 2002 to 2014. The male and female ratio was 47:18, the average age was 35.2 + 6.7 years old, the average burn area was 84.1 7.5%TBSA, and the 20-37d remained large area exposed to the wound after injury. The average was 61.1 + 8.1%TBSA. including 43 wound scab patients and 22 patients with failure of skin grafting. Among them, 8 patients accompanied high blood. Pressure, 4 patients with diabetes and 2 obese patients. All patients had no other skin diseases, basic diseases such as immunodeficiency or defect, no hormone, immunosuppressant and other drugs. The positive rate of local bacterial culture in.2. before skin grafting was 94.1%, 92.2%, 89. of MEEK skin grafting wounds, respectively. 5%, the distribution of bacteria was mainly Staphylococcus aureus, Acinetobacter baumannii, Streptococcus viridans, Pseudomonas aeruginosa and coagulase-negative staphylococci.3. naked eye observation: 7-10 days after the mixed transplantation, the autologous skin slices began to expand to four weeks, 14-20d self skin epidermis expanded and fused, and the epidermis of the allograft was gradually autologous The epidermis was crawling, instead of.3-4 weeks. After gross observation, the allogenic dermis was still clear. The allograft dermis and autologous dermis were blurred with the time of transplantation. The residual wound surface was skin grafting 21-59 days after the burn. The average repair wound area of the mixed transplantation group, the particle skin transplantation group and the MEEK skin transplantation group was 27.0%TBSA, 25.0%TBSA, 24.0%TBSA. mixed, respectively. The wound healing rate of the transplanted group was significantly higher than that of the skin grafting group and the MEEK transplantation group, which were 91.8 + 3.7%, 66.5 + 6.9% and 75.4 + 5.1% (P0.001) respectively. The multiple linear regression analysis showed that the skin grafting method, the skin grafting site, the basal disease could affect the healing rate of the wound, and the wound healing rate of the skin and Meek skin was less than that of the allograft under the same condition. The skin graft mixed transplantation was lower than 24.567%, and 16.799%. was tested by Levene. The stability of the wound healing rate (SD=3.7) was higher than that of SD=6.9 (F=23.779, P=0.000), but there was no significant difference in the healing rate of skin grafting (F=5.726, P=0.019) with MEEK (F=5.726, P=0.019) for 1-2 years, and the Vancouver scar scale score mixed transplantation group was significantly lower than the particle skin. The transplantation group had statistical significance (mixed group: n=20,4.20 + 1.47; particle skin group: n=16,6.00 + 2.37, P=0.008). There was no statistical significance between the mixed transplantation group and the MEEK transplantation group (MEEK group: n=12; 4.33 + 1.61, P=0.813).5. transplantation containing the tattoo pattern allograft, 2 months to 2 years after the operation, and the arrangement of the tattoo particles in the dermis, collagenous fiber arrangement There was no obvious inflammatory reaction in the surrounding tissue. The dermal papillomidoid structure was formed and similar to the adjacent autologous dermal structure. Conclusion autologous and cryopreserved allograft transplantation significantly increased the proportion of autologous skin, and the survival rate was high and stable after transplantation, and the allograft true skin could be used as a dermis substitute and improved the healing of the wound. It provides a selective method for the repair of large area deep wounds in the middle and late period of burn. Second typical cases report the treatment of 1. large area burn patients. It is essential to ensure the success of the skin graft transplantation, that is, the success of the operation is based on the first part. In order to improve the survival of the patients with large area and deep burn, it is very important to ensure the success of the operation. In order to improve the treatment effect of the patients with large area and deep burn, we used the autograft of autologous small skin graft in the early stage, and the survival rate of the mixed graft is high and the survival rate is stable, and the survival rate is stable, and the survival rate is stable. To shorten the treatment time, significantly improve the success rate of the patients, and reduce the cost of hospitalization. Next, reports on the typical cases of the typical case of.2. Kunshan explosion in the case of Kunshan explosion in August 2, 2014, the typical cases of the Kunshan explosion were reported to be typical cases of the 3 patients, and the area of the burned area of the III degree burns was more than 90%TBSA. More than 80%TBSA. for the first time, the first time was to give anti shock, anti infection, nutritional support, change medicine treatment, smooth through the shock period and take the eschar treatment. Autologous allograft small skin graft was used to repair the wound successfully. Case one: the patient was 43 years old, and the dust deflagration burn was 98% TBSA, and the area of III degree burns was MEEK after sixth days of 90%TBSA. injury. After skin grafting, 4 times of autologous and frozen allograft small skin graft were mixed, the residual burn wound was about 27%TBSA 30 days after injury, and the wound was basically repaired on 65 days after injury. Case two: the patients were 39 years old, and the dust deflagration burned the whole body 90%TBSA, and the area of III degree burn was MEEK skin grafting for the eighth days after 82%TBSA. injury, and then 4 autologous and cryopreserved allograft were performed. The residual burn wound on the 30 day after injury was about 20%TBSA and 61 days after injury, the wound was basically repaired. Case three: the patient was 46 years old, 46 years old, and the dust deflagration burned the whole body 96%TBSA, and the area of III degree burn was MEEK skin grafting for seventh days after the 90%TBSA. injury, and then the autologous and cryopreservation small skin graft was mixed, and the burn wound was retained on 30 days after the injury. About 25%TBSA, the wound was basically repaired 67 days after the injury.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R644
[Abstract]:Background extra large area deep burn, due to the extreme shortage of autologous skin source, can not repair the wound in a short time. In the middle and late stages, the wound basement granulation tissue is proliferated, local infection, and the survival rate of the skin graft is low. The large area naked wound often faces ultra high metabolism, sepsis, multiple organ dysfunction syndrome, even life threatening, mega area. Treatment of deep burn is still a major challenge for clinicians. According to Robert Kraft, Wang Cheng, Tuener Osler and others, the success rate of the treatment of burn area 60%-69%TBSA is 87.1%, and the cure rate is only 47.8% when the burn area is greater than 90%TBSA. Repairing the wound in time is one of the key factors to improve the success rate of the treatment. The skin grafting, skin grafting and skin grafting of the skin, although it can improve the survival rate, reduce the scar hyperplasia and restore the function as much as possible, but because of the insufficient expansion ratio, it is not suitable for the repair of large area deep burn wounds. At present, the methods of repairing large area deep wounds mainly include autoepidermal cell culture and transplantation, Meek skin grafting, Chinese type skin grafting, large skin graft and autologous small skin graft, however, the autologous epidermal cell culture and transplantation due to the lack of severe dermis scar, the latter three due to the cover of biofilm or allograft, the secretion is not easy to drain, the infection may be increased, the survival rate of the skin is unstable. In summary, the present stage is still lack of transplantation survival. Therefore, it is urgent to find a method that can be used to repair large area deep burn wound with small area autologous skin source. This study is a difficult problem to be solved in the repair of burn. After 12 years of clinical observation, the method made the proportion of autologous skin up to 9-16 times, the survival rate of the transplant was 91.8 + 3.7%. and the allogenic dermis existed for a long time and reduced the scar formation as a dermal substitute. This method provides a alternative solution for the repair problem of large area deep burn wounds. Part 1 autologous allograft. The mixed transplantation of small skin graft to repair large area residual wounds in the middle and late stages of burn proved that the autologous allograft transplantation not only significantly increased the proportion of autologous skin expansion, but also had a strong ability to tolerate infection, which could effectively repair large area deep burn wounds and provide migration for the repair of large area deep wounds in the middle and late period of burn. The method of planting a high and stable and reliable survival rate. Method 1. retrospective analysis: from 2002 to 2014, 65 cases of burn patients were treated in the burn center which met the standard of this test. 21 cases were repaired with autologous and cryopreserved allograft transplantation, 27 cases and 17 cases were repaired by particle skin grafting and MEEK skin grafting. Data (sex, age, basic disease, wound area, burn site, complication), using the Excel2013 table to record the relevant data of.2. skin graft before the skin transplantation to collect the secretions of different parts of the wound, and collect the specimens in time, determine the species of the strains, and calculate the positive rate of the surface bacteria (the number of bacteria culture positive wounds / the total number of wounds * 100%). The wound healing process was observed after.3., the healing time of wound healing was recorded, and the percentage of wound healing was recorded. First, whether the difference of wound healing rate in the mixed transplantation group and the particle skin graft group and the MEEK transplantation group was statistically significant; secondly, the influencing factors of the wound healing process were analyzed; finally, the mixed transplantation group was compared with that of the mixed transplantation group. Whether the difference of the survival rate stability of the skin graft survival in the MEEK transplantation group was statistically significant.4. follow-up observation for 1 to 2 years, the Vancouver scar scale was used to evaluate the healing quality of the wound, and the difference between the mixed transplantation group and the particulate skin transplantation group and the MEEK transplantation group was statistically significant.5. using tattoo technique for the small allograft The follow-up time was 1 years -2 years. The immuno histochemical tracing of allogenic dermis and.6. statistical methods: Shapiro-Wilk test, Levene test, T test, Mann-Whitney U test, Mauchly test, Mann-Whitney U, chi square test or Fisher exact probability, multivariate linear regression, Logistic regression analysis were used for statistical analysis. Results 1. retrospective analysis of 65 severely burned patients from 2002 to 2014. The male and female ratio was 47:18, the average age was 35.2 + 6.7 years old, the average burn area was 84.1 7.5%TBSA, and the 20-37d remained large area exposed to the wound after injury. The average was 61.1 + 8.1%TBSA. including 43 wound scab patients and 22 patients with failure of skin grafting. Among them, 8 patients accompanied high blood. Pressure, 4 patients with diabetes and 2 obese patients. All patients had no other skin diseases, basic diseases such as immunodeficiency or defect, no hormone, immunosuppressant and other drugs. The positive rate of local bacterial culture in.2. before skin grafting was 94.1%, 92.2%, 89. of MEEK skin grafting wounds, respectively. 5%, the distribution of bacteria was mainly Staphylococcus aureus, Acinetobacter baumannii, Streptococcus viridans, Pseudomonas aeruginosa and coagulase-negative staphylococci.3. naked eye observation: 7-10 days after the mixed transplantation, the autologous skin slices began to expand to four weeks, 14-20d self skin epidermis expanded and fused, and the epidermis of the allograft was gradually autologous The epidermis was crawling, instead of.3-4 weeks. After gross observation, the allogenic dermis was still clear. The allograft dermis and autologous dermis were blurred with the time of transplantation. The residual wound surface was skin grafting 21-59 days after the burn. The average repair wound area of the mixed transplantation group, the particle skin transplantation group and the MEEK skin transplantation group was 27.0%TBSA, 25.0%TBSA, 24.0%TBSA. mixed, respectively. The wound healing rate of the transplanted group was significantly higher than that of the skin grafting group and the MEEK transplantation group, which were 91.8 + 3.7%, 66.5 + 6.9% and 75.4 + 5.1% (P0.001) respectively. The multiple linear regression analysis showed that the skin grafting method, the skin grafting site, the basal disease could affect the healing rate of the wound, and the wound healing rate of the skin and Meek skin was less than that of the allograft under the same condition. The skin graft mixed transplantation was lower than 24.567%, and 16.799%. was tested by Levene. The stability of the wound healing rate (SD=3.7) was higher than that of SD=6.9 (F=23.779, P=0.000), but there was no significant difference in the healing rate of skin grafting (F=5.726, P=0.019) with MEEK (F=5.726, P=0.019) for 1-2 years, and the Vancouver scar scale score mixed transplantation group was significantly lower than the particle skin. The transplantation group had statistical significance (mixed group: n=20,4.20 + 1.47; particle skin group: n=16,6.00 + 2.37, P=0.008). There was no statistical significance between the mixed transplantation group and the MEEK transplantation group (MEEK group: n=12; 4.33 + 1.61, P=0.813).5. transplantation containing the tattoo pattern allograft, 2 months to 2 years after the operation, and the arrangement of the tattoo particles in the dermis, collagenous fiber arrangement There was no obvious inflammatory reaction in the surrounding tissue. The dermal papillomidoid structure was formed and similar to the adjacent autologous dermal structure. Conclusion autologous and cryopreserved allograft transplantation significantly increased the proportion of autologous skin, and the survival rate was high and stable after transplantation, and the allograft true skin could be used as a dermis substitute and improved the healing of the wound. It provides a selective method for the repair of large area deep wounds in the middle and late period of burn. Second typical cases report the treatment of 1. large area burn patients. It is essential to ensure the success of the skin graft transplantation, that is, the success of the operation is based on the first part. In order to improve the survival of the patients with large area and deep burn, it is very important to ensure the success of the operation. In order to improve the treatment effect of the patients with large area and deep burn, we used the autograft of autologous small skin graft in the early stage, and the survival rate of the mixed graft is high and the survival rate is stable, and the survival rate is stable, and the survival rate is stable. To shorten the treatment time, significantly improve the success rate of the patients, and reduce the cost of hospitalization. Next, reports on the typical cases of the typical case of.2. Kunshan explosion in the case of Kunshan explosion in August 2, 2014, the typical cases of the Kunshan explosion were reported to be typical cases of the 3 patients, and the area of the burned area of the III degree burns was more than 90%TBSA. More than 80%TBSA. for the first time, the first time was to give anti shock, anti infection, nutritional support, change medicine treatment, smooth through the shock period and take the eschar treatment. Autologous allograft small skin graft was used to repair the wound successfully. Case one: the patient was 43 years old, and the dust deflagration burn was 98% TBSA, and the area of III degree burns was MEEK after sixth days of 90%TBSA. injury. After skin grafting, 4 times of autologous and frozen allograft small skin graft were mixed, the residual burn wound was about 27%TBSA 30 days after injury, and the wound was basically repaired on 65 days after injury. Case two: the patients were 39 years old, and the dust deflagration burned the whole body 90%TBSA, and the area of III degree burn was MEEK skin grafting for the eighth days after 82%TBSA. injury, and then 4 autologous and cryopreserved allograft were performed. The residual burn wound on the 30 day after injury was about 20%TBSA and 61 days after injury, the wound was basically repaired. Case three: the patient was 46 years old, 46 years old, and the dust deflagration burned the whole body 96%TBSA, and the area of III degree burn was MEEK skin grafting for seventh days after the 90%TBSA. injury, and then the autologous and cryopreservation small skin graft was mixed, and the burn wound was retained on 30 days after the injury. About 25%TBSA, the wound was basically repaired 67 days after the injury.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R644
【参考文献】
相关期刊论文 前2条
1 彭代智;;皮肤混合移植的现状和未来[J];中华烧伤杂志;2007年06期
2 夏照帆 ,肖仕初,杨s，
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