Micrografting in Major Burn Treatment-Experience of Taichung Veteran General Hospital

顯微移植皮膚在重度燒傷病人的治療－台中榮總的經驗

曾凱邦(Kae-Bang Tzeng) ； 顏榮信(Jung-Hsing Yen) ； 簡文祥(Wen-Hsiang Chien) ； 林雍球(Yung-Chiou Lin) ； 陳伊呈(I-Chen Chen) ； 唐友文(Yu-Wen Tang)

《臺灣整形外科醫學會雜誌》 19卷3期 (2010/09) Pp. 209-220

https://doi.org/10.7096/TJTSPS.201009.0209

摘要

背景：
大面積燒傷病患治療的核心問題是缺乏可用的自體皮膚移植。Meek在1958年發明了一種大量擴張郵票式自體皮膚移植的手術技術。Kreis則在1993 年改進了他的方法，稱之爲顯微皮膚移植。而今顯微皮膚已被廣泛地使用在大面積燒傷的病患。
目的及目標：
就一般的觀念而言，顯微皮膚移植後的疤痕要比傳統網狀皮膚移植明顯。然而這個觀點較少有文獻探討。因此我們追蹤本院使用顯微皮膚移植的大面燒傷病患並評估其疤痕的嚴重程度。
材料及方法：
從1999年9月到2006年9月期間，有10個重度燒傷病人接受了15次的顯微皮膚移植。病人的平均年齡是30.1歲（範圍：19到47歲）。平均燒傷面積爲67.8%體表面積（範圍：24到90%體表面積）。顯微皮膚移植的擴張率從1:4到1:9。平均追蹤時間爲25個月（範圍：5到65個月）。
結果：
經過不織布戳洞、提早換藥及使用銀磺銨藥膏的改良，在15次的顯微皮膚移植手術中，一次植皮的面積平均爲1799平方公分（範圍：847到3810平方公分）。移植皮膚的平均存活率爲82.6%。使用的軟木塞片數平均爲16片且一次手術的花費平均爲新台幣32000元。疤痕指數(Vancouver Scar Scale)平均爲5.27（範圍：3到8）。疤痕的疼痛度平均值爲0.63。
結論：
在同一位病人，同樣深度的燒傷傷口的植皮比較，我們發現顯微皮膚移植後的疤痕並未比傳統網狀皮膚移植的疤痕嚴重。

並列摘要

Background:
The most difficult problem in major burn treatment is the lack of an autograft donor site. In 1958, Meek devised a technique that used widely expanded postage stamp autografts. Kreis modified Meek's technique in 1993 and called it ”micrograft”. Since then, the micrograft technique has been commonly used for patients with major burns.
Aim and Objective:
Generally, the scarring from micrografting is severer than that from traditional meshed graft. However, discussion in this concept is few in the past. In this study, we reviewed 10 cases of patients with major burn wounds and compared the quality of the scars from the two grafting techniques used.
Materials and Methods:
From Sept. 1999 to Sept. 2006, 10 patients received micrografting treatment in 15 separate operations in Taichung Veteran General Hospital. The mean age of these patients was 30.1 years (range: 19-47 years). The mean burn area was 67.8% TBSA (range: 24-90% TBSA). The expansion rate varied from 1:4 to 1:9. The mean follow up time was 25 months (range: 5-65 months).
Results:
To increase the graft survival rate and control infection in all our patients, we used three procedures: 1) expanded pre-folded gauzes were punctured several times before application, 2) the external dressing was changed on the first post-operation day, and 3) silver sulfadiazine was applied daily from the 7th post-operation day. In the 15 micrografting treatments, the mean area grafted per procedure was 1799±747.4 cm^2 (range 847-3810 cm^2). The mean graft survival rate was 82.6%. The mean number of dampened cork plates used was 16, and the mean cost of cork plates per operation was NT$32000. In the follow up periods, the mean Vancouver Scar Scale was 5.27±1.9 (range 3-8). The mean score of scar pain was 0.63±2.1. We also evaluated the scarring from the traditional meshed skin grafts at the same time in four patients. The mean Vancouver Scar Scale was 7±1.6 from meshed skin graft and 7±1.4 from micrograft. The mean pain score was 3.25±2.4 from meshed skin graft and 0 from micrograft.
Conclusion:
In the same patient with same condition of burn wounds, there was no obvious difference in scar severity between the micrograft and meshed graft.

並列關鍵字

meek ； micrograft ； meshed graft ； scar severity ； Vancouver Scar Scale Introduction