【摘要】 目的介绍一种应用动力取皮机定量削痂并覆盖大张自体皮修复手部深Ⅱ度烧伤的方法.方法本科自2001年1月至2004年6月共用此方法治疗112例深Ⅱ度烧伤病人的148只手.伤后2~72 h手术.根据临床创面判断的深度定量削痂,将动力取皮机固定在0.012 inc、0.016 inc或0.02 inc(0.3 mm、0.4 mm或0.5 mm)的刻度上,削去坏死组织,确切保留基本正常组织.并依据保留下组织的情况将其分为Ⅰ类,真皮深层基本完好并有点状乳头层残留;Ⅱ类,真皮部分网状层存在伴有脂肪珠;Ⅲ类,完整的皮下脂肪存在并伴有毛囊等附属结构.然后分别使用大张表皮、大张韧厚皮、大张中厚皮移植覆盖.结果112例深Ⅱ度烧伤病人的148只手,削痂部位移植大张表皮的68只手及移植大张韧厚皮、大张中厚皮的80只手皮片存活良好,外形平整,功能基本恢复正常(图1~3).痂皮厚度调查发现平均厚度0.4~0.8 mm,与设定的动力刀刻度基本一致,组织学检测发现此种状态下表皮、真皮的厚度大于正常状态下真皮厚度的2倍左右.结论依据烧伤后皮肤增加了的厚度定量削除坏死组织,并依据保留组织的完好程度采用不同厚度的自体覆盖物可以达到最佳的治疗效果.更多还原

【Abstract】 Objective Introducing a technique of quantitative eschar shaving with great sheet of epidermal grafting for deep Ⅱdegree burns in hands.Method 148 hands from 112 patients were treated with this methods.From Jan.2001 to Jane 2004,patients who suffered from deep Ⅱdegree burn injuries was quantitatively eschar shaving using electrical or air power dermatome which was fixed at scale mark from 0.012 inc 、0.016 inc to 0.02inc(from 0.3mm 、0.4mm to 0.5mm) according to the burn injury extents,the wounds were divided into three groups just depends on the injury extents,also the wounds was covered with the different thickness of great sheet of epidermal grafting,which was obtained using the electric or air dermatomes.Results There were 148 hands of 112 cases were treated with this technique within 2h.to 72h after injury.The scar thickness was ranged from 0.4mm to 0.8mm,the function of these hands was good,and the shape of hands looks good.Conclusion Good results was obtained with this methods,the wounds covered with the large sheet of epidermal grafting harvested by the quantitative eschar shaving is recovered uneventful.The thickness of the grafting was according to the increasing skin thickness after burns.更多还原