[Clinical effects of artificial dermis combined with vacuum sealing drainage and autologous split-thickness skin graft in repair of scar contracture deformity after extensive burn].

Objective: To explore the clinical effects of artificial dermis combined with vacuum sealing drainage (VSD) and autologous split-thickness skin graft in repair of scar contracture deformity after extensive burn. Methods: A total of 8 patients with scar hyperplasia and contracture deformity on joint after healing of extensive burn were admitted to our hospital from August 2015 to August 2017. There were 5 females and 3 males aged 8 to 45 years with an average of 23 years. In the first stage operation, scar tissue on contracture site was removed, and the wound was covered by artificial dermis followed by continued VSD treatment. On 10-14 d after the first stage operation, the artificial dermis tissue formed, and the second stage autologous split-thickness skin grafting and continued VSD treatment were performed. Routine anti-scar therapy was carried out after healing of wounds. Time of wound healing after the second stage operation was recorded. Colour and texture of the split-thickness skin graft, scar formation condition of the donor site, and action condition of the operation site during follow-up were observed. Results: The wounds of 8 patients were healed in 10-14 d after the second stage operation. During follow-up of 6-24 months, the split-thickness skin graft was with smooth surface and good elasticity, and the function of joint recovered well. The donor site in head healed well with no scar. Only pigmentation was left in the donor site of thigh, and scar was not obvious. The patients and their family members were satisfied. Conclusions: After application of artificial dermis combined with VSD and autologous split-thickness skin graft in repair of scar contracture deformity after extensive burn, the skin grafting area and donor site were with unobvious scar hyperplasia, and the joint function in the operation area was good.目的： 探讨人工真皮联合负压封闭引流(VSD)及自体刃厚皮移植整复大面积烧伤后瘢痕挛缩畸形的临床效果。 方法： 2015年8月—2017年8月，笔者单位收治8例大面积烧伤治愈后瘢痕增生伴关节挛缩畸形患者，其中女5例、男3例；年龄8～45岁，平均23岁。Ⅰ期手术切除挛缩部位的瘢痕组织后，用人工真皮覆盖创面，并行持续VSD治疗。Ⅰ期手术后10～14 d，类真皮组织形成，行Ⅱ期自体刃厚皮移植手术，并继续行持续VSD治疗。创面愈合后常规行抗瘢痕治疗。记录Ⅱ期术后创面愈合时间；观察随访时所移植刃厚皮色泽、质地，供皮区瘢痕形成情况及术区关节活动情况。 结果： 8例患者Ⅱ期手术后10～14 d创面愈合。术后随访6～24个月，植皮区移植刃厚皮表面光滑，弹性良好，关节功能恢复良好。头部供皮区愈合良好，无瘢痕遗留；大腿供皮区仅遗留色素沉着，瘢痕不明显，患者及家属均满意。 结论： 人工真皮联合VSD及自体刃厚皮移植整复大面积烧伤后瘢痕挛缩畸形，术后植皮区及供皮区瘢痕增生不明显，术区关节功能较佳。.