CAJ | 학술논문

背景：既往头部取皮一般使用滚轴式取皮刀取皮，对操作者的经验要求较高，经验不足时易导致取皮过厚，取皮后影响患者头发生长，且所取皮片边缘呈明显锯齿状，皮片利用率及供皮区利用率均不高。目的：比较注液肿胀法联合气动植皮机与联合滚轴式取皮刀行头部取皮应用效果。方法：采用气动植皮机联合注液肿胀法行头部取皮的37例特重度烧伤患者为植皮机组，与采用滚轴式取皮刀联合注液肿胀法行头部取皮的38例特重度烧伤患者(滚轴刀组)临床资料进行比较，两组均行刃厚皮片移植(皮片厚度约0.3 mm)。统计分析两组取皮片时间、皮片大小、厚薄均匀及边缘整齐程度、供皮区愈合时间、移植皮片成活率。结果与结论：使用注液肿胀法后头部取皮易于操作，取皮中、取皮后出血明显减少。气动植皮机组取皮平均用时7.9 min，较滚轴刀组平均缩短3 min(P <0.05)，所取皮片较大，边缘整齐，厚薄均匀，最大皮片达12 cm×5 cm，供皮区均一期愈合，平均愈合时间5.5 d，较滚轴刀组平均缩短2.2 d(P <0.05)。两组患者头部供皮区均一期愈合，未出现头皮感染、坏死、小灶瘢痕或脱发。结果表明，气动植皮机联合注液肿胀法是一种简单高效的头部取皮方法，对于大面积特重度烧伤患者具有显著优越性和重要临床应用价值。
배경：기왕두부취피일반사용곤축식취피도취피，대조작자적경험요구교고，경험불족시역도치취피과후，취피후영향환자두발생장，차소취피편변연정명현거치상，피편이용솔급공피구이용솔균불고。목적：비교주액종창법연합기동식피궤여연합곤축식취피도행두부취피응용효과。방법：채용기동식피궤연합주액종창법행두부취피적37례특중도소상환자위식피궤조，여채용곤축식취피도연합주액종창법행두부취피적38례특중도소상환자(곤축도조)림상자료진행비교，량조균행인후피편이식(피편후도약0.3 mm)。통계분석량조취피편시간、피편대소、후박균균급변연정제정도、공피구유합시간、이식피편성활솔。결과여결론：사용주액종창법후두부취피역우조작，취피중、취피후출혈명현감소。기동식피궤조취피평균용시7.9 min，교곤축도조평균축단3 min(P <0.05)，소취피편교대，변연정제，후박균균，최대피편체12 cm×5 cm，공피구균일기유합，평균유합시간5.5 d，교곤축도조평균축단2.2 d(P <0.05)。량조환자두부공피구균일기유합，미출현두피감염、배사、소조반흔혹탈발。결과표명，기동식피궤연합주액종창법시일충간단고효적두부취피방법，대우대면적특중도소상환자구유현저우월성화중요림상응용개치。
BACKGROUND:Previously, a roling dermatome was often used to take skin tissues from the head, which demands a higher experience for an operator. Lack of experience easily leads to too thick skin tissues and impact hair growth in patients, and harvested skin tissues have a jagged edge that influences the enough utilization of harvested skin tissues and donor site. OBJECTIVE:To explore the clinical effects of air dermatome combined with infusion tumescent technique versus roling dermatome combined with infusion tumescent technique to take the skin from the head. METHODS: Clinical data from 37 patients with severe burn undergoing air dermatome combined with infusion tumescent technique (experimental group) and 38 patients with severe burn undergoing roling dermatome combined with infusion tumescent technique (control group) were compared. Both of the two groups underwent razor-thin graft (skin thickness was about 0.3 mm). The time of harvesting skin grafts, skin size, whether the skin grafts had uniform thickness and clean edges, healing time of skin donor sites, and survival rate of skin grafts were statisticaly analyzed in the two groups. RESULTS AND CONCLUSION:Infusion tumescent technique made the operation easy. Intraoperative and postoperative bleeding was significantly reduced. The mean time for harvesting skin grafts was 7.9 minutes in the <br> experimental group, which was 3 minutes shorter than that in the control group (P < 0.05). In the experimental group, the skin grafts were larger with clean edges and uniform thickness, and the maximum graft was 12 cm×5 cm in size; al the donor sites were primarily healed, and the average healing time was 5.5 days, which was 2.2 days shorter than that in the control group (P < 0.05). Al the donor sites in the two groups were primarily healed with no scalp infection, smal scars or hair loss. Results from this study show that the air dermatome combined with infusion tumescent technique is a simple and effective method for harvesting skin grafts from the head and it has the remarkable superiority and important clinical value in extremely severe burn patients.