CAJ | 학술논문

目的观察密集式缝合固定法在颌颈部深度烧伤创面或烧伤后瘢痕畸形创面皮肤移植修复术中的临床应用效果.方法 2002年4月-2011年12月,将笔者单位收治的114例颌颈部深度烧伤及烧伤后瘢痕畸形患者按照随机数字表法分为打包组和密集缝合组,每组57例(48例烧伤患者、9例瘢痕畸形患者),均移植自体中厚断层皮片修复创面.打包组患者按照打包法固定皮片,密集缝合组患者按密集式缝合固定法固定皮片.术后14d,观察移植皮片的微循环灌流量及皮下血肿、术区感染、皮肤坏死情况;术后6个月,观察创缘瘢痕增生、移植皮肤弹性及挛缩情况.对计量资料行u检验,计数资料行Fisher确切概率法检验或x2检验.结果 (1)术后14 d,密集缝合组、打包组皮片的微循环灌流量分别为(2.86 ±0.18)、(2.33 ±0.15)V,组间比较差异有统计学意义(u=17.776,P＜0.05).(2)术后14d,打包组4例、密集缝合组3例患者出现皮下血肿,组间比较差异无统计学意义(x2 =0.152,P＞0.05).(3)术后14d,打包组1例患者发生术区感染,密集缝合组无一例患者发生术区感染,组间比较差异无统计学意义(P＞0.05).(4)术后14 d,打包组6例患者移植皮肤出现片状坏死,密集缝合组无一例患者移植皮肤出现片状坏死,组间比较差异有统计学意义(P＜0.05).(5)术后6个月,打包组21例、密集缝合组6例患者创缘呈现“蜈蚣腿”样瘢痕增生,组间比较差异有统计学意义(x 2 =10.920,P＜0.05).(6)术后6个月,打包组17例、密集缝合组4例患者移植皮肤弹性差,组间比较差异有统计学意义( x2=9.865,P＜0.05).(7)术后6个月,打包组15例、密集缝合组4例患者移植皮肤明显挛缩,组间比较差异有统计学意义(x 2=11.684,P＜0.05).结论密集式缝合固定法适合于颌颈部创面大张皮肤移植,成活率高,便于术后观察.
목적 관찰밀집식봉합고정법재합경부심도소상창면혹소상후반흔기형창면피부이식수복술중적림상응용효과.방법 2002년4월-2011년12월,장필자단위수치적114례합경부심도소상급소상후반흔기형환자안조수궤수자표법분위타포조화밀집봉합조,매조57례(48례소상환자、9례반흔기형환자),균이식자체중후단층피편수복창면.타포조환자안조타포법고정피편,밀집봉합조환자안밀집식봉합고정법고정피편.술후14d,관찰이식피편적미순배관류량급피하혈종、술구감염、피부배사정황;술후6개월,관찰창연반흔증생、이식피부탄성급련축정황.대계량자료행u검험,계수자료행Fisher학절개솔법검험혹x2검험.결과 (1)술후14 d,밀집봉합조、타포조피편적미순배관류량분별위(2.86 ±0.18)、(2.33 ±0.15)V,조간비교차이유통계학의의(u=17.776,P＜0.05).(2)술후14d,타포조4례、밀집봉합조3례환자출현피하혈종,조간비교차이무통계학의의(x2 =0.152,P＞0.05).(3)술후14d,타포조1례환자발생술구감염,밀집봉합조무일례환자발생술구감염,조간비교차이무통계학의의(P＞0.05).(4)술후14 d,타포조6례환자이식피부출현편상배사,밀집봉합조무일례환자이식피부출현편상배사,조간비교차이유통계학의의(P＜0.05).(5)술후6개월,타포조21례、밀집봉합조6례환자창연정현“오공퇴”양반흔증생,조간비교차이유통계학의의(x 2 =10.920,P＜0.05).(6)술후6개월,타포조17례、밀집봉합조4례환자이식피부탄성차,조간비교차이유통계학의의( x2=9.865,P＜0.05).(7)술후6개월,타포조15례、밀집봉합조4례환자이식피부명현련축,조간비교차이유통계학의의(x 2=11.684,P＜0.05).결론 밀집식봉합고정법괄합우합경부창면대장피부이식,성활솔고,편우술후관찰.
Objective To observe the clinical effect of the concentrated suture fixation method on skin transplantation on deep burn wound or wound of cicatricial deformity after burn in the jaw and neck region. Methods One hundred and fourteen patients,hospitalized from April 2002 to December 2011,with deep burn or cicatricial deformity after burn in the jaw and neck region,were divided into packaging group and concentrated suture group according to the random number table.Each group had 57 patients including 48 cases with deep burn and 9 cases with cicatricial deformity.Traditional suture-package fixation method and concentrated suture fixation method were respectively used in packaging group and concentrated suture group to fix the autologous medium split-thickness skin in transplantation on wounds or scars.On post operation day (POD) 14,the skin microcirculatory perfusion flow of skin graft was measured,and the occurrence of ecchymoma,infection,and necrosis of skin in operative region were observed.The elasticity and contracture of grafted skin and scar hyperplasia on wound edge were observed 6 months after operation. Measurement data were processed with u test,while enumeration data with Fisher's exact test or Chi-square test.Results ( 1 ) On POD 14,the skin microcirculatory perfusion flow in concentrated suture group [ (2.86 ±0.18) V] was significantly higher than that in packaging group [ (2.33 ±0.15) V,u =17.776,P ＜0.05 ].(2) Ecchymoma occurred in 4 patients of packaging group and 3 patients of concentrated suture group,but the difference between two groups was not statistically significant (x 2 =0.152,P ＞ 0.05 ).(3)Infection in operative region was observed in 1 patient of packaging group,while no patient in concentrated suture group showed this symptom.The difference between two groups was not statistically significant ( P ＞0.05).(4) Grafted skin in 6 patients of packaging group showed foliated necrosis,which was not observed on those of patients in concentrated suture group.The difference between two groups was statistically significant ( P ＜0.05).(5) Centipede leg-like scar hyperplasia on wound edge occurred in 21 patients in packaging group and 6 patients in concentrated suture group,and the difference between two groups was statistically significant (x 2 =10.920,P ＜ 0.05 ).(6) Poor elasticity of grafted skin was detected in 17 patients of packaging group and 4 patients of concentrated suture group,and the difference between two groups was statistically significant (x 2 =9.865,P ＜0.05 ).(7) Obvious contracture of grafted skin was observed in 15 patients of packaging group and 4 patients of concentrated suture group,and the difference between two groups was statistically significant ( x 2 =11.684,P ＜ 0.05 ). Conclusions Concentrated suture fixation method is suitable for application in transplantation of big sheet skin on wound in the jaw and neck region.It has high survival rate and is convenient for postoperative observation.